BIG HOMIES INC employment application

BIG HOMIES INC LITTLE HOMIES LLC

2605 Elliott Ave Portsmouth, VA 23702
EMPLOYMENT/VOLUNTEER APPLICATION
All information in this document is confidential.
Last Name
First Name Use legal name
Middle
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address
Apt
City
State
Zip
Birthdate

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Physical limitations be specific if none write none
VOLUNTEER EXPERIENCE
Interests Skills Hobbies
Clubs Organizations you belong to
Education highest level
Name of School
Have you volunteered before
Position
Describe the work
Agency
Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
May we contact the Agency
Your availability hours per week
Preferred Days
Geographic Preference( age group)
Name of current employer
Address
Date Employment Began

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Name of Supervisor
Job Title
Description of duties
Does your employer have a community partnership?
REFERENCES (Personal or professional; not a relative)
Name
Relationship
Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name
Relationship
Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name
Relationship
Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
IN CASE OF EMERGENCY, PLEASE NOTIFY
Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
If you are applying for a position that requires driving, Big Homies requires a valid driver's license? Are you able to useyour automobile if the position requires and provide proof of insurance?
As an employee/volunteer, I agree to provide a valid driver's license number and proof of automobile insurance. I agree to mail or deliver copies of these documents to Big Homies Inc, SO that they can be filed with this application. I will immediately notify my volunteer supervisor if my driver's license is restricted, suspended, revoked, or expired.
Insurance Carrier
Policy
Drivers License
State of Issue
Expiration Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Have you ever been convicted of a misdemeanor or felony, or are any misdemeanor or felony charges pending against you? If yes, please explain below. (Note: Answering yes will not automatically prohibit individuals from becoming volunteers or employees, but will be considered with respect to time, circumstances, seriousness and relationship to volunteer or employment responsibilities. Some positions may require a background check. If you are selected for one of those assignments, you will be provided with a separate criminal background check authorization form
Have you ever been convicted of, pled guilty/no contest to, or have pending charges for any criminal offense — including any involving a minor, vulnerable adult, drugs, alcohol (e.g., DUI), or violence? If yes, please explain (date, charge, disposition).
Are you required to register as a sex offender in any state, or have you ever had a professional license/certification revoked or suspended?
Have you ever been named as a defendant in a civil lawsuit involving allegations of abuse, neglect, negligence, or harm to a child or vulnerable person?
Do you consent to a background check — including criminal history, sex offender registry, and child abuse/neglect registry checks — and, if applicable, drug/alcohol testing, as a condition of employment?
Big Homies acknowledges that equal opportunity for all persons is a fundamental human value. Each applicant will be considered based on individual ability and merit, without regard to race, color, age, religion, national origin, disability, sexual orientation, sex, or marital status.

PARENTAL CONSENT (to be completed if applicant is under 18 years of age) I give my consent for my child, named on page one of this application, to provide volunteer or employment services to Big Homies I also give Big Homies my consent to obtain any emergency medical treatment necessary for the safety of my child.
My signature below certifies that all statements made on this application are true, complete and correct to the best of my knowledge and belief. I understand these statements are subject to verification. I understand that falsification on this application can disqualify me from consideration or result in my volunteer or employment services being denied. Furthermore, my signature below provides my authorization to Big Homies to conduct driver license and motor vehicle record checks as needed, as well as reference checks to determine my suitability for placement. I hereby release all parties from any liability for furnishing this information.
Signature of Applicant
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Printed name of ParentGuardian
Signature of ParentGuardian
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

BIG HOMIES INC LITTLE HOMIES LLC

EMPLOYMENT/VOLUNTEER APPLICATION

VOLUNTEER EXPERIENCE

IN CASE OF EMERGENCY, PLEASE NOTIFY