Delaware Opportunities Application for Employment

Application for Employment

DELAWARE OPPORTUNITIES, INC.
35430 State Highway 10, Hamden, NY 13782

Phone: (607) 746-1600 Email: info@delop.org Fax: (607) 746-1605
PERSONAL INFORMATION
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Phone Number*
Format: (000) 000-0000.
Drivers License #
Are you eligible to work in the US?

YesNo
Are you at least 18 years or older? (If no, you may be required to provide authorization to work.)

YesNo
Can you work overtime, including weekends?

YesNo
Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?

YesNo
REFERRAL SOURCE
How did you hear about us?

Walk InAdvertisementReferralOther
Have you ever worked for this company before? Yes No
Explain:blank
Do you know anyone who works for our company? Yes No
If yes, who?blank
EMPLOYMENT DESIRED
Position Desired*
Date you can start:

MonthDayYear
Date
Hourly Rate/Salary Desired
EDUCATION

Rows	Name and Location of School	Degree Received	Subjects Studied/Major
High School
College or University
Trade, Business or Correspondence School

EMPLOYMENT HISTORY

List below your last four employers, starting with the most recent.
Employer Name
Job Title
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address
Employment Start Date

MonthDayYear
Date
Employment End Date

MonthDayYear
Date
Reason for Leaving
Employer Name
Job Title
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address
Employment Start Date

MonthDayYear
Date
Employment End Date

MonthDayYear
Date
Reason for Leaving
Employer Name
Job Title
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address
Employment Start Date

MonthDayYear
Date
Employment End Date

MonthDayYear
Date
Reason for Leaving
Employer Name
Job Title
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address
Employment Start Date

MonthDayYear
Date
Employment End Date

MonthDayYear
Date
Reason for Leaving
Do you have any special skills, experience, and/or training that would enhance your ability to perform the position applied for? If yes, explain.
Please do not exceed 200 words.
REFERENCES

Give the names of three people not related to you, who can provide employment related references.

Rows	Name	Company	Phone	Email
1.
2.
3.

Please read carefully before signing.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Delaware Opportunities to hire me. If I am hired, I understand that either Delaware Opportunities or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Delaware Opportunities has the authority to make any assurance to the contrary. I attest with my signature below that I have given to Delaware Opportunities true and complete information on this application. No requested information has been concealed. I authorize Delaware Opportunities to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.
This application is only valid for 60 days from signature date.
Delaware Opportunities is an equal opportunity employer. Delaware Opportunities does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service or any other characteristic protected by law.
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Application for Employment

PERSONAL INFORMATION

REFERRAL SOURCE

EMPLOYMENT DESIRED

EDUCATION

EMPLOYMENT HISTORY

REFERENCES