Application for Employment

Employer:

City/State:

Supervisor:

Supervisor Title:

Phone:

Format: (000) 000-0000.

Your Position:

Dates of Employment:

Full-Time/Part-Time/Seasonal:

Start Salary:

End Salary:

Reason for leaving:

Have you ever been convicted of a felony?

If YES, please explain:

or indicate N/A

Do you have any physical limitations or special needs?

Please list any computer or IT programs, software, or systems you are experienced in/are comfortable using:

Have you ever been employed by this chapter or any other Ronald McDonald House chapters?

If yes, dates:

Location:

Have you ever volunteered for this chapter or any other Ronald McDonald House chapters?

If yes, dates:

Location:

(Please list three (3) references with phone numbers)

Name:

Title:

Phone:

Format: (000) 000-0000.

Company:

Relationship:

Years Known:

Name:

Title:

Phone:

Format: (000) 000-0000.

Company:

Relationship:

Years Known:

Name:

Title:

Phone:

Format: (000) 000-0000.

Company:

Relationship:

Years Known:

By applying for employment at Ronald McDonald House Central PA, I authorize Ronald McDonald House Central PA to contact my references or otherwise validate the information I have shared. I authorize Ronald McDonald House Central PA to conduct a child abuse, criminal background, and FBI clearance check. I agree to maintain privacy of any donor, guest, and/or patient information. I certify that all statements on this application are true and complete to the best of my knowledge.

Applicant Signature:

Date:

MonthDayYear

Ronald McDonald House Central PA is an equal opportunity employer and does not discriminate against any employee or applicant based on race, color, gender, national origin, age, religion, disability, veteran's status, or sexual orientation.

REV 5.11.26

Application for Employment

EDUCATION

EMPLOYMENT HISTORY (Begin with most recent/current)

PROFESSIONAL REFERENCES