North Atlantic Security: Application Form

Application For Employment

This is a pre-employment questionnaire for an equal opportunity employer. Feel free to append resumes, reference lists, writing samples, or other pertinent materials.

Desired Employment
For which county are you applying?

Walker CountyStatewide (please type county below)
Please type desired county.
Position Applied For
Date you can start

MonthDayYear
How did you hear about this position?
Please list any friends, acquaintances, or relatives already working for CHOH
Person's name - select Friend/Acquaintance/Relative
Are you currently employed?

YesNo
If yes, in what capacity?
Have you ever applied to work at Caring Hands & Open Hearts in the past?

YesNo
If yes, please supply the details of your employ:

Educational History
Please chose the highest level of education you have completed:

Grammar SchoolMiddle SchoolHigh SchoolCollegeGraduate SchoolTrade School
Please provide details on colleges, graduate schools, and trade schools you have attended.

Enter your education history below*

References
Please give the names of 3 people (other than family) whom you have known for at least 1 year.
First Reference
Full Name*

First NameLast Name
Phone Number*

Area CodePhone Number
How do you know this person?*
Years Known*
Second Reference
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
How do you know this person?
Years Known
Third Reference
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
How do you know this person?
Years Known

Felony Record
Have you been convicted of a felony within the last 5 years?

YesNo
If yes, please attach a statement explaining the circumstances. A felony record will not necessarily exclude you from consideration for a position at Caring Hands & Open Hearts, LLC.

Authorization
Electronic Signature*

First NameLast Name
Application Completed*

MonthDayYearHourMinutesAM/PM Option
I Certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed falsified statements on this application and on appended materials may be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand that no representative 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, unless it is in writing and signed by an authorized Caring Hands & Open Hearts, LLC representative.
I have read and agree to the above statement*

I agree
Date

MonthDayYear
Date
Signature

Clear
Should be Empty:

Application For Employment