Clone of Luther Home Job Application Form

APPLICATION FOR EMPLOYMENT
Position Applied For
Apply for:
Full Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Shift(s) applying for (please tick all that you are applying for):
Are you available for weekends?
Educational History
Please provide your educational history, including the following details for each institution: Name and location of the institution. Date completed (or graduation date). Degree, diploma, or certificate obtained
If you did not complete high school, do you have a high school equivalency diploma?
Experience
1.
Employer:
Dates :
Department & Type of Work:
Duties:

2.
Employer:
Dates :
Department & Type of Work:
Duties:

3.
Employer:
Dates :
Department & Type of Work:
Duties:Please provide the following information for each position you have held: Employer Dates of employment (from and to). Department Type of work and primary duties. If this information is already included in your attached résumé, you may proceed to the next section.
Use this space for any additional information you think would help us evaluate your application, including training, workshops or specialized skills:
License, certificate or other authorization to practice a trade or profession.
Type:
License Number:
Granted by (licensing board):Type, License Number and Granted by (licensing board)
References
1.
Name:
Email Address:
Phone:
Relationship:

2.
Name:
Email Address:
Phone:
Relationship:

3.
Name:
Email Address:
Phone:
Relationship:List names, email addresses, and relationship of 3 persons not related to you, in supervisory or academic capacities who know your qualifications.
Are you legally authorized to work in Canada?
Current Work Status:
If you are working under a work permit or as an international student with work authorization, when is the expiry date?

MonthDayYear
Date
If you are working under a work permit or as an international student with work authorization, do you have any restrictions on the number of hours you can work?
Have you ever been convicted of any violation of law, excluding moving traffic violations?
If yes, please provide a description of the offense:
CERTIFICATION Each Application Requires Current Date and Original Signature

I hereby certify that all entries and attachments are true and complete, and I agree and understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture on my part of any employment in the service of Luther Home. I understand that all information on this application is subject to verification and I consent to criminal history background checks. I also consent that you may contact references, former employers and educational institutions listed regarding this application. I further authorize Luther Home to rely upon and use, as it sees fit, any information received from such contacts. Information contained on this application may be disseminated to other agencies, facilities, nongovernmental organizations or systems on a need to-know basis for good cause shown as determined by Luther Home.
Date completed

MonthDayYear
Date
Signature
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APPLICATION FOR EMPLOYMENT