Clone of VVSC Volunteer Prescreening

Application for Employment

Thank you for your interest in working with us! Please complete the form below so we can learn more about you and match you with the right opportunities.
PERSONAL INFORMATION
Name

First NameLast Name
Phone Number

Area CodePhone Number
E-mail
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a citizen of the United States?
If no, do you have the legal right to work in the United States?
Are you willing to undergo a background check?
Are you able to obtain a level 1 Fingerprint Clearance card?
Do you have any physical limitations or medical conditions we should be aware of?
If yes, please explain
Position you are applying for
EDUCATION
High School
Years completed
College/University
Degree
Other training or certifications
EMPLOYMENT HISTORY
Most recent employer
Job title
Dates employed
Rate of pay
Supervisor
Phone
Responsibilities
Reason for leaving
Previous employer
Job title
Dates employed
Rate of pay
Supervisor
Phone
Responsibilities
Reason for leaving
List 3 references, please provide names, phone numbers, and relationship
Applicant’s Statement & Authorization
I certify that the information provided in this application is true and complete to the best of my knowledge. I authorize investigation of all statements contained herein, and I understand that false or misleading information given in my application or interview(s) may result in discharge if employed.
Signature
Date

MonthDayYear
Date
Please verify that you are human
Should be Empty:

Application for Employment