Application for Employment

Application for Employment

In order that your application may be properly evaluated, it is essential that all of the following questions be answered carefully and completely.
Date*

MonthDayYear
Date
Name*

First NameMiddle 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
Position Desired: *
Hours Desired, Pick One:*

Full TimePart TimeEither
When can you start?*
How were you referred to Partners in Housing? *
High School or Preparatory: Name, Location, Years Completed, Major, GPA, Degree (s) obtained*
College: Name, Location, Years Completed, Major, GPA, Degree(s) obtained
Graduate school: Name, Location, Years Completed, Major, GPA, Degree(s) obtained
Other:
List any additional skills, technical or professional knowledge which you may have: *
Are you vaccinated against COVID-19?*

Employment Experience:

List all of your current and previous positions (paid and unpaid) in chronological order starting with most recent. Please complete this section and attach additional sheets as needed even if you submit a resume
1.) Employed From and To: *
Company Name*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your title and Department*
Supervisors Name and Title: *
Supervisors Number:
Please enter a valid phone number.
Work Performed: *
Reason for leaving: *
2.) Employed From and To:
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your title and Department
Supervisors Name and Title:
Supervisors Number:
Please enter a valid phone number.
Work Performed:
Reason for leaving:
3.) Employed From and To:
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your title and Department
Supervisors Name and Title:
Supervisors Number:
Please enter a valid phone number.
Work Performed:
Reason for leaving:
4.) Employed From and To:
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your title and Department
Supervisors Name and Title:
Supervisors Number:
Please enter a valid phone number.
Work Performed:
Reason for leaving:
5.) Employed From and To:
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your title and Department
Supervisors Name and Title:
Supervisors Number:
Please enter a valid phone number.
Work Performed:
Reason for leaving:
6.) Employed From and To:
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your title and Department
Supervisors Name and Title:
Supervisors Number:
Please enter a valid phone number.
Work Performed:
Reason for leaving:
7.) Employed From and To:
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your title and Department
Supervisors Name and Title:
Supervisors Number:
Please enter a valid phone number.
Work Performed:
Reason for leaving:
Of the jobs held, what did you like the most, and why?*
Of the jobs held, what did you like the least, and why?*
May we contact your present employer?*

YesNo

WE ARE REQUIRED DO A CRIMINAL BACKGROUND CHECK ON ALL EMPLOYEES
Has anyone ever brought or threatened to bring a civil or criminal claim against you alleging physical or sexual abuse or sexual harassment by you?*

YesNo
If Yes, give a short explanation of the complaint. Please indicate the date, nature, and place of the incident leading to the complaint, where the complaint was filed, and the disposition of the complaint.
Has any employer ever disciplined you or terminated your employment or have you ever terminated your own employment for reasons related to physical or sexual abuse by you, sexual harassment by you, your unsafe driving, or your theft?*

YesNo
If Yes, give a short explanation of the allegations. Please indicate the date, nature, and place of the allegations, the disposition of the allegations, and your employer at the time, including your employer's name, address and telephone number.
Have you ever received any medical treatment, physical or psychological, for reasons involving physical abuse or sexual abuse by you?*

YesNo
If yes, give a short explanation of the treatment, including date(s), nature and location(s), identifying the treating physician with name, address and telephone number.
Do you or a member of your immediate family or household or a relative have an active child welfare case or pending referral?*

YesNo

Please list 3 references:
1.) Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
2.) Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3.) Name*

First NameLast Name
Relationship *
Phone Number*
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
In order for your application to be considered, you must sign the
Applicant’s Declaration, Authorization and Release below.
APPLICANT'S DECLARATION, AUTHORIZATION, AND RELEASE

My answers on this application and on any resume I provide are complete and true. I understand that the submission of any false or incomplete information in connection with my application, whether on this or other documents or in interviews, will be cause for the rejection of my application or the termination of my employment at any time. I authorize Partners in Housing and its agents to verify any information related to my application or resume. I also authorize all individuals, schools, employers, and law enforcement officials to freely release any information concerning my background, and I hereby release any and all of them from any liability for doing so
Name*

First NameLast Name
Signature*

Clear
Date

MonthDayYear
Date
Please attach a resume to supplement this application

Cancelof
Should be Empty:

Application for Employment

Employment Experience:

WE ARE REQUIRED DO A CRIMINAL BACKGROUND CHECK ON ALL EMPLOYEES

Please list 3 references:

APPLICANT'S DECLARATION, AUTHORIZATION, AND RELEASE