Wings of Refuge: Employment Application

Name

First Name Last Name
Middle Initial
Date

Month Day Year
Date
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Email
example@example.com
Date Available to Start
Desired Wage $
Days Available to Work

No Preference Monday Tuesday Wednesday Thursday Friday Saturday Sunday
I am Seeking A

Full Time Job Part Time Job Full or Part Time Job
How many hours can you work weekly?
Can you works Nights?
Date Available to Start
Position Applied For
Do you Have a Driver's License?

Yes No
Driver's License Number
State (for driver's license)
Are you a citizen of the United States?

Yes No
If No, are you authorized to work in the United States?

Yes No
Have you ever worked for this company?

Yes No
If Yes, when?
Have you ever been convicted of a felony?

Yes No
If Yes, explain
Where did you attend High School?
When did you attend high school?
From (Date) blanks to (Date) blank
Did you graduate?

Yes No
Where did you attend College?
Address of College
When did you attend College? (Dates)
Did you graduate?

Yes No
Degree:
Other (Any other schooling)
Address (for other schooling)
When did you attend? (Dates)
Did you graduate?

Yes No
Degree:
Please list three professional preferences (preferably one pastoral reference.)
Full Name (1)
Relationship (1)
Company (1)
Phone (1)
Address (1)
Email Address (1)
Full Name (2)
Relationship (2)
Company (2)
Phone (2)
Address (2)
Email Address (2)
Full Name (3)
Relationship (3)
Company (3)
Phone (3)
Address (3)
Email Address (3)
Work Experience (Start with most recent/current)
Company (1)
Phone
Address
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilities
Dates work(ed)there
Reason for leaving
May we contact your previous supervisor for a reference?

Yes No
Company (2)
Phone Number
Address
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilities
Dates worked here
Reason for leaving
May we contact your previous supervisor for a reference?

Yes No
Company (3)
Phone
Address
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilities
Dates worked here
Reason for leaving
May we contact your previous supervisor for a reference?

Yes No
Military History
Branch
Dates
Rank at Discharge
Type of Discharge
If other than honorable, explain
"I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. "
Signature

Clear
Date

Month Day Year
Date
Should be Empty:

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