Coffers Housing Solutions

Creating a family home to assist you in a warm , safe environment

EMPLOYMENT APPLICATION
TODAYS DATE: ___________
PERSONAL INFORMATION:
NAME:
LAST

FIRST

MIDDLE

ADDRESS:
STREET
CONTACT INFORMATION:

(APT)

CITY/STATE

(
)
HOME PHONE

)
MOBILE

SOCIAL SECURITY#________________________

ZIP
EMAIL

DATE OF BIRTH_____/_____/____

DRIVERS LICENSE#_____________________
How did you learn about the company? Internet/ Friend/Other
Felonies or misdemeanors? Yes/No Explain________________

Have you ever been convicted of a

crime? Yes/No Explain

Are you VCE certified? __YES __ No

If yes, Please list your certifications and last update
______________________________ Year:___________
______________________________ Year:___________
______________________________ Year:___________
______________________________ Year:___________

Are you trained in CPR? __Yes __No

Are you trained in First Aide? __Yes __No

___________________ Year:____________
___________________ Year:___________
____________________ Year:___________
____________________ Year:___________

Year:______________
Year:______________

POSITION SOUGHT:__________________________

AVAILABLE START DATE:_________

ARE YOU CURRENTLY EMPLOYED?_______________________

EDUCATION

NAME AND
LOCATION

GRADUATE?
DEGREE?

MAJOR SUBJECT OF
STUDY

HIGH SCHOOL

COLLEGE/UNIVERSITY

SPECIALIZED TRAINING

OTHER EDUCATION
PLEASE LIST YOUR AREAS OF HIGHEST PROFICIENCY, SKILLS OR OTHER ITEMS THAT MAY
CONTRIBUTE TO YOUR ABILITIES IN PERFORMING THE ABOVE MENTIONED POSITION

Coffers Housing Solutions

Creating a family home to assist you in a warm , safe environment

____________________________________________________________________________________________