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APPLICATION FOR EMPLOYMENT
WE ARE AN EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER
APPLICANT'S STATEMENT
I understand that The Place is committed to providing equal opportunity in all employment practices, including but not limited to selection, hiring, promotion, transfer, and compensation to all qualified applicants and employees without regard to age, race, color, national origin, sex, religion, handicap or disability, or any other category protected by federal, state or local law.
I authorize former and present employers, and professional, work, and personal references listed in the application, and any other individuals I may name to give The Place and/or its designee any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release such parties from all liability for any damages that may result from furnishing same to the The Place. I also authorize The Place to provide truthful information concerning my employment with it to future employers, and I agree to hold it harmless for providing such information.
I understand that The Place reserves the right, to the extent permitted by law, to require drug and alcohol screening tests of an applicant or an employee either prior to employment or any time during employment, and I hereby give my consent to such tests. I consent to the release of the results of any such tests to The Place or its designee. I release The Place and/or its designee from any and all liability and damages which may result or arise from any drug test or the provision of information in connection with such a test.
I understand that this employment application and any other Company documents are not promises of employment. Should I be employed, I understand that my employment will be on a trial period for ninety (90) days from the date of my hiring and that I will remain an at-will employee thereafter. I further understand that if I am employed, I can terminate my employment at any time with or without cause and with or without advanced notice and that The Place has a similar right. I understand that no manager, representative, or agent of the Company has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing, except that the CEO may do so in writing.
The information given by me on this application and during the interview process is true and complete in all respects, and I agree that if the information is found to be false, misleading, or unsatisfactory in any respect (in the Company's judgment), that I will be disqualified from consideration for employment or subject to immediate dismissal if discovered after I am hired.
I CERTIFY THAT I HAVE RECEIVED A SEPARATE WRITTEN NOTIFICATION THAT THE COMPANY MAY OBTAIN A CONSUMER REPORT ON ME FOR USE IN CONNECTION WITH MY APPLICATION AND IF I AM HIRED, MY EMPLOYMENT WITH THE COMPANY. I AUTHORIZE THE COMPANY TO OBTAIN THIS REPORT. THIS APPLICATION WILL BE CONSIDERED "ACTIVE" FOR A MAXIMUM OF THIRTY (30) DAYS.TO BE CONSIDERED FOR EMPLOYMENT AFTER THAT TIME, YOU MUST REAPPLY.
DO NOT SIGN UNTIL YOU HAVE READ AND UNDERSTAND THESE STATEMENTS.
*
Indicates required field
Date:
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Applicant's Signature (Full Name):
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Each inquiry on this application must be
fully answered
or
completed
. Otherwise you will not be considered for employment.
PERSONAL DATA
Last Name:
*
First Name:
*
Middle Name:
*
Present Address:
*
Line 1
Line 2
City
State
Zip Code
Country
How long have you lived there?
Years:
*
Months:
*
Previous Address:
*
Line 1
Line 2
City
State
Zip Code
Country
How long have you lived there?
Years:
*
Months:
*
Telephone Number(s):
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Social Security Number
*
Are you 18 years of age or older?
*
Yes
No
Position Desired, Select One
*
Specify
Youth Event Coordinator
Placement Desired:
*
Full-time
Part-time
Temporary
BACKGROUND INFORMATION
Please explain fully any gaps in your employment history. Be sure to account for all periods of time including military service and any period of unemployment.
*
List any other names which you may have used and which will be necessary to verify prior to your employment:
*
If hired, can you provide proof that you are legally entitled to work in the U.S.?
*
Yes
No
If not, what steps must be taken for you to begin employment lawfully?
*
Have you ever been terminated or asked to resign from any job?
*
Yes
No
If yes, please explain your circumstances:
*
May we contact your current employer?
*
Yes
No
If no, please explain:
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Have you ever worked for this Company before?
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Yes
No
If yes, give dates and position:
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Do you have any friends or relatives working here or for one of our other companies?
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Yes
No
If yes, Name(s) and Relationship:
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How were you referred to us?
*
Have you ever pleaded "no contest," nolo, guilty, or been convicted of a crime?
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Yes
No
Are any charges currently pending against you?
*
Yes
No
Has any adjudication ever been withheld?
*
Yes
No
(NOTE: Answering "Yes" to these questions does not constitute an automatic bar to employment.) If you answered yes to any of the preceeding questions, please give dates and details:
*
Do you have any commitments to any other employer which may affect your employment?
*
Yes
No
Education
School name
High School:
*
Years Completed:
*
1
2
3
4
Diploma / Degree:
*
Describe Course of Study or Major:
*
Describe Specialized Experience, Training, Skills, and Extra-Curricular Activities:
*
College/University:
*
Years Completed:
*
1
2
3
4
Diploma / Degree:
*
Describe Course of Study or Major:
*
Describe Specialized Experience, Training, Skills, and Extra-Curricular Activities:
*
Graduate/Professional:
*
Years Completed:
*
1
2
3
4
Diploma / Degree:
*
Describe Course of Study or Major:
*
Describe Specialized Experience, Training, Skills, and Extra-Curricular Activities:
*
Trade or Correspondence:
*
Years Completed:
*
Diploma / Degree:
*
Describe Course of Study or Major:
*
Describe Specialized Experience, Training, Skills, and Extra-Curricular Activities:
*
PREVIOUS EMPLOYMENT
Please list the names of your present or previous employers in chronological order with present or last employer listed first. Include part-time and seasonal employment. If self-employed, give firm name and supply business references. DO NOT ANSWER "SEE RESUME." Fill out this form completely.
Employer 1:
*
Telephone Number(s):
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Job Title:
*
Supervisor Name & Title:
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Reason for Leaving:
*
Dates Employed:
From:
*
To:
*
Choose One:
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Hourly Rate
Salary
Starting:
*
Final:
*
Worked Performed:
*
Employer 2:
*
Telephone Number(s):
*
Job Title:
*
Supervisor Name & Title:
*
Reason for Leaving:
*
Dates Employed:
From:
*
To:
*
Choose One:
*
Hourly Rate
Salary
Starting:
*
Final:
*
Worked Performed:
*
Employer 3:
*
Telephone Number(s):
*
Job Title:
*
Supervisor Name & Title:
*
Reason for Leaving:
*
Dates Employed:
From:
*
To:
*
Choose One:
*
Hourly Rate
Salary
Starting:
*
Final:
*
Worked Performed:
*
Employer 4:
*
Telephone Number(s):
*
Job Title:
*
Supervisor Name & Title:
*
Reason for Leaving:
*
Dates Employed:
From:
*
To:
*
Choose One:
*
Hourly Rate
Salary
Starting:
*
Final:
*
Worked Performed
*
Employer 5:
*
Telephone Number(s):
*
Job Title:
*
Supervisor Name & Title:
*
Reason for Leaving:
*
Dates Employed:
From:
*
To:
*
Choose One:
*
Hourly Rate
Salary
Starting:
*
Final:
*
Worked Performed:
*
RELEVANT EXPERIENCE
Please indicate positions you have held in prior jobs:
Management /Supervision:
*
General Manager
Operations Manager
Sales Manager
Loan Officer
Office Manager
Supervisor
Office / Administration / Sales:
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Accounting
General Clerical
Secretary
Switchboard / Receptionist
Sales Representative
Customer Service
Retail:
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Cashier
Merchandising
Warehouse
Backroom intake
Supervisor
Pricing
Other:
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Other:
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Other:
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List any professional designations, certifications, licenses, or courses that may be applicable to the position for which you are applying:
*
OTHER INFORMATION
Please describe any other experience that you have which would be relevant to the job for which you are applying:
*
DRIVING INFORMATION
(Complete only if driving is an essential function of the job for which you are applying.)
Do you have a valid driver's license?:
*
Yes
No
If yes, License No.:
*
Expiration Date:
*
If you do not have a driver's license for the state in which you currently reside, why not?
*
Has your license ever been suspended or revoked?
*
Yes
No
If yes, please explain:
*
Do you have personal automobile insurance?
*
Yes
No
If no, please explain:
*
Have you ever been denied personal automobile insurance or has it ever been terminated or suspended ?
*
Yes
No
If yes, please explain:
*
Have you ever been convicted, pled guilty, or pled nolo to a charge of DWI or DUI?
*
Yes
No
Are any charges currently pending against you? If yes to either question, explain:
*
Please list all moving traffic violations in the past five (5) years:
Offense 1:
*
Date:
*
Location:
*
Comments:
*
Offense 2:
*
Date:
*
Location:
*
Comments
*
Offense:
*
Date:
*
Location:
*
Comments:
*
Submit
ABOUT US
Mission, Vision & Values
History
Financials
News & Events
Staff
>
Job Opportunities
Board of Directors
Contact Us
Ways to Support
Financial Donations
>
Give Now
Matching Gifts
Fundraise
Non-Cash / In-Kind Donations
>
Food Donations
Thrift Store Donations
Vehicle Donation
Host a Drive
Volunteer
>
Volunteer Opportunities
Volunteer Portal
Court Mandated Community Service
Need Help?
Food Pantry
Thrift Store
Financial Assistance
Assistance with Federal Aid Applications
Workforce Development & Education
The Cottage
Senior Outreach
Youth Outreach
Donate Now
Support Us
Support Us
