SND USA Employment App

EDUCATION
Highest level of education completed*
Degree
Special training, certificates, licenses:
Special skills, foreign languages:
EMPLOYMENT HISTORY
Please share your last three employers starting with the most recent.
Name of Employer #1*
Address*

Address

Street Address Line 2

CityState

Zip
Phone Number*

Area CodePhone Number
Starting date*

MonthDayYear
Date
Leaving date*

MonthDayYear
Date
Job title*
Description of work*
May we contact your supervisor?

YesNo
Name and Title of Supervisor
Reason for leaving*
Name of Previous Employer #2
Address

Address

Street Address Line 2

CityState

Zip
Phone Number

Area CodePhone Number
Starting date

MonthDayYear
Date
Leaving date

MonthDayYear
Date
Job title
May we contact your supervisor?

YesNo
Name and Title of Supervisor
Description of work
Reason for leaving
Name of Previous Employer #3
Address

Address

Street Address Line 2

CityState

Zip
Phone Number

Area CodePhone Number
Starting date

MonthDayYear
Date
Leaving date

MonthDayYear
Date
Job title
May we contact your supervisor?

YesNo
Name and Title of Supervisor
Description of work
Reason for leaving

REFERENCES
Professional Reference #1 - Name
Professional Reference #1- Phone

Area CodePhone Number
Professional Reference #1- Email
example@example.com
Your connection to Reference #1
Professional Reference #2- Name
Professional Reference #2- Phone

Area CodePhone Number
Professional Reference #2- Email
example@example.com
Your connection to Reference #2
Professional Reference #3- Name
Professional Reference #3- Phone

Area CodePhone Number
Professional Reference #3- Email
example@example.com
Your connection to Reference #3
SERVICE RECORD
Have you ever served in the US Armed Forces?*

YesNo
Branch of Service
Discharge Date

MonthDayYear
Date
Rank
Have you ever been convicted of, or plead guilt /no contest to, or had a suspended imposition of sentence for any offense (other than a minor traffic violation)?*

YesNo
If yes, please explain:
A convictional record will not necessarily exclude you from consideration. This information will be used only for job-related purposes and only to the extent permitted by law.
AUTHORIZATION
I certify that the facts contained in this application are true and complete to the best of my knowledge and I understand that any misstatements or omission of information is grounds for ending the hiring process, or, if employed for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you and any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release this company from all liability for any damage that may result from utilization of such information. I also understand and agree 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 company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans With Disability Act (ADA) and other relevant Federal and State laws.*
Name/Signature
Date*

MonthDayYear
Sisters of Notre Dame 1601 Dixie Highway, Covington, KY 41011 humanresources@sndky.org
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Application for Employment

PERSONAL INFORMATION

DESIRED EMPLOYMENT

EDUCATION

EMPLOYMENT HISTORY

REFERENCES

SERVICE RECORD

AUTHORIZATION