Employment Application

Employment Application

Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin, marital or veteran status, disability, or any other legally protected status.

Rowan Helping Ministries is an Equal Opportunity Employer

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Email

example@example.com

Are you over 18 years of age?*

YesNo

Are you legally authorized to work in the United States?*

YesNo

Have you been convicted of a crime in the past ten years?*

YesNo

If yes, please explain:

Have you worked for Rowan Helping Ministries before?*

YesNo

If yes, please list employment dates and position:

Position applying for:

Shelter AttendantCrisis Support SpecialistCase ManagerOther

Date you can start:

Salary requirements:

How did you hear about this position?

What shifts are you available to work? (check all that apply)

What is your preferred work schedule?

Employment History

List your last three employers or volunteer activities, starting with the most recent, including military.

Employer

Are you currently employed here?

YesNo

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Last supervisor's name:

Supervisor's title:

May we contact for reference?

YesNo

Position Description:

Reason for leaving:

Employer

Are you currently employed here?

YesNo

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Last supervisor's name:

Supervisor's title:

May we contact for reference?

YesNo

Position Description:

Reason for leaving:

Employer

Are you currently employed here?

YesNo

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Last supervisor's name:

Supervisor's title:

May we contact for reference?

YesNo

Position Description:

Reason for leaving:

Have you ever been disciplined or fired for insubordination, violating safety rules, fighting, assault, participant abuse, or alcohol/drug related activity at work?

Have you ever been placed on probation or terminated for poor performance or absenteeism?

If yes, please explain:

Education & Training

High School*

Diploma/GED Received *

College/Technical School

Graduate School

Please use the following space to mention any special skills, qualifications, achievements or experiences, not covered elsewhere on this application, that may be relevant to employment at Rowan Helping Ministries.

References

Please list three persons, other than relatives, who have knowledge of your work experience and/or education.

Reference #1*

Reference #2

Reference #3

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Signature

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