Application for Employment -

Name *

First

Middle

Last

Are you 18 years of age? *

Yes
No
Check here if over 19 (age requirement to drive vans only)

Do you have a valid driver's license? *

Yes
No

Full Present Address *

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address (if different)

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone Number

Cell Phone Number *

Email *

Position Applied For *

How did you hear about us? *

If referred by someone, please put their name here.

Do you have the legal right to work in the US? (According to Federal Law, work authorization documentation will be required upon employment) *

Yes
No

Have you filed an application with or been employed by this Agency before? If yes, give a date.

Are you presently employed? *

Yes
No

May we contact your present employer? *

Yes
No

Date available to start? *

What are you available to work? *

Full Time
Part Time
Summer
Other

Are you on layoff and subject to recall? *

Can you travel if you are assigned to another program site? *

Yes
No

OPTIONAL: Please indicate if you speak/read/write in any foreign language.

REFERENCES: Give name, address and telephone number of four references who are not related to you, and include at least two work or professional references. Please provide four. *

Employment Experience: Start with your present or last job. Include military service assignments and any work performed on a volunteer basis. Please provide Employers Name, Address, Job Title, Phone, Supervisors Name, Reason for Leaving and Dates of Employment. Please provide three. *

Special Skills and Qualifications: Summarize special skills and qualifications acquired from employment or other experience that may be helpful in this new position.

List Certificates you have earned (such as CPR, First Aid, Defensive Driving, etc.):

Education: List the highest level of education you have received. Please provide High School (or GED) Name, College/University Name, Degree Earned, Other education or training (describe). *

EQUAL EMPLOYMENT OPPORTUNITY SELF-DISCLOSURE FORM. Sex:

Male
Female

It is my understanding that this employment application, or the granting of a verbal interview, does not represent a contract of employment or a promise of future benefits by this organization. I understand and agree that if hired, my employment will be “at will” in nature and may be terminated with or without cause at any time, by either myself or my employer. I also understand that this written statement supersedes any and all verbal representations made by agents or representatives of this agency or organization. AGREEMENT: I certify that the information on this application is true, complete and correct. I authorize THE CENTER OF HOPE to investigate my past employment, education and activities and I release from all liability all persons, companies and corporations supplying such information. I understand that false answers, statements or significant omissions made by me on this form shall be sufficient cause for denial of employment or discharge.

Application for Employment

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