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?*

YesNo
If no, do you have the legal right to work in the United States?

YesNo
Are you willing to undergo a background check?*

YESNO
Are you able to obtain a level 1 Fingerprint Clearance card?*

YESNO
Do you have any physical limitations or medical conditions we should be aware of?*

YESNO
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*

Clear
Date*

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

Application for Employment