Our House, Inc.'s Employment Form

Full Name *

First Name Middle Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Contact Phone Number *

Area Code Phone Number

E-mail *

example@example.com

Birth Date

Month Day Year

Social Security Number *

Are You a U.S. Citizen? *

Yes No

If no, are you authorized to work in the U.S.?

Yes No

Have you ever been convicted of a felony? *

Yes No

If yes, explain?

Type of Felony

Position Applying For

Date You Can Start

Date

Hourly Salary Desired *

Per Hour or Per Job completed

Have You Worked Here Before?

Yes No

Have You Applied Here Before?

Yes No

High School *

Name of High School Attended

Number of Years Attended *

Graduated? *

Yes No

College

Name of College/University Attended

Number of Years Attended

Graduated?

Yes No

Area of Study/Degree

Graduate School

Name of Graduate School Attended

Number of Years Attended

Graduated?

Yes

Area of Study/Degree

Trade School/Other

Name of Trade/Technical/Other School Attended

Number of Years Attended

Graduated?

Yes

Area of Study/Degree

Skills

List any relevant skills

Qualifications

List any relevant certifications or qualifications

Current Employer/Company Name

Name of Current Employer or NONE if not Employed

Supervisor's Name

Current Employer

Email Address

Supervisor or Human Resources - Email Address

Position

Salary

Reason for Leaving?

Start Date

Date

May We Contact?

Yes No

Previous Employer/Company

Name of Previous Employer/Company worked at

Previous Supervisor's Name

Name of Previous Employer

Position

Your Position at this place of employment

Email Address

Previous Employer

Salary

Reason for Leaving?

Start Date

Date

End Date

Date

Previous Employer/Company

Name of Previous Employer

Previous Employer/Supervisor

Name of Previous Employer/Supervisor

Email Address

Email Address for Supervisor or Human Resources

Your Position

Your position at this employment

Salary

Reason for Leaving?

Start Date

Date

End Date

Date

Reference 1 *

Name of Reference

Relationship *

Years Acquainted *

Phone *

Email *

Reference 2 *

Name of Reference

Relationship *

Years Acquainted *

Phone *

Email *

Reference 3 *

Name of Reference

Relationship *

Years Acquainted *

Phone *

Email *

Cover Letter

Upload a File

Resume

Upload a File

Copy of Driver License

Upload a File

Copy of Social Work or Counseling License

Upload a File

Copy of Car Insurance

Upload a File

Have you ever been convicted of a felony or misdemeanor other than minor traffic violation, and/or been placed on probation, fined or given a suspended sentence in court? This includes any convictions in military court and any criminal charges for which you are awaiting trial. In the comment section below, list all cases other than minor traffic violations. (Driving under the influence, reckless driving or hit-and-run ARE NOT MINOR traffic violations. Your fingerprints may at some point be sent to state and federal agencies and all service will be subject to satisfactory review of any criminal convictions. PLEASE NOTE: A full disclosure by you is to your advantage as your record does not constitute on automatic bar to services. Factors such as but not limited to your age at the time of the offense(s), type of offenses(s) as well as the relationship between the offense(s) and the job(s) for which you apply will be taken into account. However, failure to admit convictions will result in disqualification. (Statement taken from Victim Service Center of Central Florida)

Have you ever been charged with a criminal offence?

Have you ever had a criminal record sealed and/or expunged?

I, certify that all the information contained in this application is correct and complete to the best of my knowledge. I understand that falsification of this application in any details is grounds for disqualification for further consideration or dismissal from the service. I hereby authorize investigation of all statements I have made herein. I authorize the persons or companies herein referenced to give information regarding my past employment, together with any information that they have regarding me, whether or not it is in their records. I hereby release said persons and companies from all liability for any damages whatsoever resulting from issuing or obtaining this information. Additionally, I am not currently serving on the governing entity and understand that no preferential treatment will be given in applying for the volunteer program. If selected to serve with the Our House agency, I agree to comply by all its policies, procedures, rules and regulations, Acceptance as a volunteer will include the receipt of information related to the law enforcement background checks. As such, some of the materials presented will be privileged and confidential in nature. Due to the sensitivity of this information, it is necessary for Our House, Inc. to conduct background checks to determine the suitability of those persons desiring to become volunteers. This includes a drug background check. I certify that I meet the following requirements below.

I am nineteen years of age or older I currently have and will maintain state-reliable transportation I currently have and will maintain state-required vehicle insurance I currently have and will maintain a working cell phone I understand that there will be no texting on my cell phone while driving I am able to make twenty-four (24) month commitment to the Our House I am able to complete forty 40-hour orientation training in order to provide direct services
Each check box certify my agreement with Our House, Inc.

By clicking the submit button below, I cerity that all of the information provided by me on this application is true and complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employement may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compenstation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.

Signature: Signature
Date:   Date
Email:   Email

Employment Application:

Volunteer Information:

Personal Information:

Employment Desired:

Education:

Skills/Qualifications:

Current Employment:

Previous Employment:

References:

Attachments:

Criminal Background Questions

Certification Requirements

Send Application: