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Application for Employment 096149 Revised

Application for Employment 096149 Revised

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Published by: Henry Jacob Baker Jr on Nov 14, 2010
Copyright:Attribution Non-commercial


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Federal and state laws prohibit discrimination on the basis of sex, race, creed, religion, color, national origin,citizenship, age in accordance with applicable law, handicap, disability, medical condition, marital and veteran'sstatus in all practices, privileges and conditions of employment. (National Advocate Association) strictly adheresto these laws and regulations and will consider all qualified applicants for employment without regard to any of these factors.
Position(s) Applied ForDate of ApplicationHow Did You Learn About Us?[ ] Advertisement [ ] Friend [ ] Walk-In [ ] Employment Agency [ ] Relative[ ] Other _______________________________________________________________________________________ Last Name First Name Middle NameAddress Number Street City State Zip CodeTelephone Number(s)Social Security NumbeIf you are under 18 years of age, can you provide required proof of your eligibility to work?[ ] Yes[ ] NoHave you ever filed an application with us before?[ ] Yes[ ] NoIf Yes, give date __________________ Have you ever volunteer with us before?[ ] Yes [ ] NoIf Yes, give date __________________ Are you currently volunteering?[ ] Yes[ ] NoMay we contact your present agency?[ ] Yes[ ] NoDo you have a legal right to live and work in the United States?[ ] Yes[ ] No 
Proof of citizenship or immigration status will be required upon employment.
On what date would you be available for volunteer?______________________________ Are you available to volunteer:[ ] Full Time[ ] Part Time[ ] TemporaryAre you currently on "lay-off' status and subject to recall?[ ] Yes[ ] NoCan you travel if a job requires it?[ ] Yes[ ] NoHave you been convicted of a felony within the last 7 years?[ ] Yes[ ] No
Conviction will not necessarily disqualify an applicant from employment.
If Yes, please explain ____________________________________________________________________________________  ______________________________________________________________________________________________________  ______________________________________________________________________________________________________ WE ARE AN EQUAL OPPORTUNITY EMPLOYER 
Elementary School High SchoolUndergraduateCollege / UniversityGraduate /ProfessionalSchool Name andLocationYear Completed4 / 5 / 6 / 7 / 8 9 / 10 / 11 / 12 1 / 2 / 3 / 4 1 / 2 / 3 / 4Diploma / DegreeDescribe Course of StudyDescribe any specialized training,apprenticeship, skills and extra-curricular activitiesDescribe any honors you havereceivedState any additional information youfeel may he helpful to us inconsidering your application
Indicate any foreign languages you can speak, read and / or write
SPEAK READWRITEList professional, trade, business or civic activities and offices held. You may exclude memberships which would reveal sex,race, religion, national origin, age, ancestry, handicap or other protected status: ____________________________________________________________________________________________________  ____________________________________________________________________________________________________  ____________________________________________________________________________________________________  ____________________________________________________________________________________________________ 
Give name, address and telephone number of three references who are not related to you and are not previous employers.1. __________________________________________________________________________________________________ 2. __________________________________________________________________________________________________ 3.__________________________________________________________________________________________________ Have you ever had any job-related training in the United States military?[ ] Yes [ ] NoIf Yes, please describe ____________________________________________________________________________________  ______________________________________________________________________________________________________ 
Employment Experience
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may excludeorganizations which indicate race, color, religion, gender, national origin, handicap or other protected status.1. EmployerDates EmployedFrom /ToWork PerformedAddressTelephone Number(s)Hourly Rate/SalaryStarting /FinalJob TitleReason for LeavingSupervisor 

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