IIT Employment Application

IIT Employment Application
Position Applied For
Date Available to Start Work

MonthDayYear
Date
What days/nights and time are you available for work
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Social Security Number
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your mailing address the same as your physical address? If no, please fill out below.
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Have you ever worked for this company before?
Do you have the legal right to work in the United States?
Have you pleaded “guilty” or “no contest” to, or been convicted of, a misdemeanor, fraud or felony?
If yes, please explain.
Are you currently facing any criminal or civil prosecution?
If yes, please explain.
EDUCATION
High School Name and location:
Did you graduate?
If yes, what year did you graduate or complete your GED?
College Name
College Location
Area of Study / Degree
Did You Graduate?
If yes, what year did you graduate?

MonthDayYear
Date
List Any Continuing Education / Professional Degrees / Certifications. Please list the name of the school, location of the school and degree achieved and date completed.
EMPLOYMENT RECORD

(Most recent/current employer first.)
Name of Business
Start Date

MonthDayYear
Date
Is this your current employer? If no, please enter "End Date" below.
End Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Position
Supervisor
Responsibilities
Starting Salary and Title
Ending Salary and Title
Reason for Leaving
May we contact this employer for a reference?
Name of Business
Start Date

MonthDayYear
Date
Is this your current employer? If no, please enter "End Date" below.
End Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Position
Supervisor
Responsibilities
Starting Salary and Title
Ending Salary and Title
Reason for Leaving
May we contact this employer for a reference?
Name of Business
Start Date

MonthDayYear
Date
Is this your current employer? If no, please enter "End Date" below.
End Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Position
Supervisor
Responsibilities
Starting Salary and Title
Ending Salary and Title
Reason for Leaving
May we contact this employer for a reference?
PROFESSIONAL / WORK REFERENCES
Name

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Name

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Name

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Please provide any other information you believe should be considered for the job you are seeking.
If hired it is mandatory that “ALL” I’m In Transition employees be on Morning Devotion, Monday through Friday at 8:00 am and in attendance at the Friday evening Spiritual Recovery Meeting at 6:30pm. If your schedule interferes with these mandatory meetings please speak with the Director.
Security Check
Certification

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences immediate termination. I authorize I’m In Transition to contact my current and/or former my employers and educational organizations regarding my current and/or former employment and education. I authorize my current and/or former my employers and educational organizations to fully and freely communicate information regarding my employment, attendance and grades. I authorize those persons identified as references to freely and fully communicate information regarding my current and/or former employment and education. If an employment relationship is created, I understand unless I am offered a specific written employment offer letter, signed by the Chief Executive Officer on behalf of I’m In Transition, the employment relationship will be “at-will.” In other words, the relationship will be completely voluntary at nature, and either my employer or I can terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have that same right. Moreover, no agent, representative or employee of I’m In Transition, except in a specific written contract of employment and signed by the Chief Executive Officer on behalf of I’m In Transition has the power to vary or alter the nature of the employment relationship. In accordance with the US federal Equal Employment Opportunity Commission, it is the policy of I’m In Transition to provide equal employment opportunities to all applicants and does not discriminate on the basis of race, creed, color, ethnicity, national origin, religion, sex, sexual orientation, gender expression, age, height, weight, physical or mental ability, veteran status, military obligations, and marital status. I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.
Signature
Date

MonthDayYear
Date
Should be Empty:

IIT Employment Application

EDUCATION

EMPLOYMENT RECORD

PROFESSIONAL / WORK REFERENCES