St. Vincent de Paul Casa Grande – Employment Application

St. Vincent de Paul Casa Grande – Employment Application

Thank you for your interest in joining our team! Please complete the application below. St. Vincent de Paul serves our neighbors in need with compassion and dignity. St. Vincent de Paul Society; St. Anthony Conference — Casa Grande; 405 E. 2nd Street, Casa Grande, AZ 85122
Page 1 — Position and Personal Information
Application Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Position Applying For
Desired Hourly Pay
Available Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
First Name
Last Name
Mailing Address
City
State
ZIP
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Education Summary
Availability
How did you learn about this opening?

Page 2 — Employment History
No previous employment
Other names used during employment
Résumé upload

Cancelof
Employer history
Previous employer company name
Previous employer phone
Please enter a valid phone number.Format: (000) 000-0000.
Previous employment start month/year

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Previous employment end month/year

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Currently employed here
Previous employer address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Previous position title
Previous monthly or hourly pay
Previous duties
Reason for leaving
Employer 2 company name
Employer 2 phone
Please enter a valid phone number.Format: (000) 000-0000.
Employer 2 start month/year

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer 2 end month/year

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer 2 currently employed here
Employer 2 address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employer 2 position title
Employer 2 monthly or hourly pay
Employer 2 duties
Employer 2 reason for leaving
Employer 3 company name
Employer 3 phone
Please enter a valid phone number.Format: (000) 000-0000.
Employer 3 start month/year

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer 3 end month/year

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer 3 currently employed here
Employer 3 address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employer 3 position title
Employer 3 monthly or hourly pay
Employer 3 duties
Employer 3 reason for leaving
Employer 4 company name
Employer 4 phone
Please enter a valid phone number.Format: (000) 000-0000.
Employer 4 start month/year
MM/YYYY — for example, 06/2022
Employer 4 end month/year
MM/YYYY — for example, 06/2022
Employer 4 currently employed here
Employer 4 address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employer 4 position title
Employer 4 monthly or hourly pay
Employer 4 duties
Employer 4 reason for leaving

Page 4 — Permission to Obtain Information
Permission to Obtain Information

This document authorizes the Society of St. Vincent de Paul, Casa Grande Conference (SVDP), to seek and/or certify specific information about your background. I understand that this authorization applies whether I am a current employee, a candidate for employment, or seeking to provide services as a volunteer or as an independent contractor.

I specifically authorize that background information may be sought in the following areas and agree to release from liability the agencies, prior employers, individuals, or other entities that provide the information, to the extent the information given is true and accurate:

a. Criminal conviction records in any jurisdiction.
b. Social Security verification.
c. Driving record in Arizona or other states.
d. Educational and professional certification records in any jurisdiction.
e. Work performance, attendance, and job-related information.
f. Credit history.

I agree to assist in this effort by calling prior employers, as necessary, and asking for full disclosure of my employment history.

I further understand that information obtained may be used by SVDP, in its sole discretion and without liability, to determine eligibility for initial or continued employment/volunteer service or to grant or deny me permission to enter employer property.

I further understand that this information will become part of my personnel record at SVDP and will be held in the confidence accorded to all such records.

I acknowledge that I have read and understand this information, and that the rules governing its collection and use are pursuant to the Fair Credit Reporting Act, as amended by the Consumer Credit Reform Act of 1996, and that any adverse action based on this information will be communicated to me in accordance with the Act.
I acknowledge the Permission to Obtain Information statement
Electronic Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Page 5 — Confidential Background Information
Confidential Information Notice: The information in this section is collected for identification and background verification purposes. St. Vincent de Paul Casa Grande will treat this information as confidential and limit access to personnel authorized to handle these matters.
Other Names Used
Race / Ethnicity (Optional)

Other
Residence History for the Past Five Years
Printed Name

First NameMiddle NameLast Name
Driver’s License Number
Driver’s License State
Arizona Residency Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Page 6 — Applicant Certification
The information I have provided in this application is true, correct, and complete. If accepted for employment, I understand that misstating or omitting facts on this application may result in termination of my employment. I grant permission to check my background and references, and I release SVDP Casa Grande Conference from any and all resultant liability. If accepted for employment, I will abide by the code of conduct and the policies and procedures of SVDP Casa Grande Conference. I will be required to furnish proof of identity. I understand that, if accepted for employment, my employment can be terminated at any time, with or without reason.
Applicant Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Page 7 — Emergency Contact
Emergency Contact Full Name

First NameLast Name
Relationship to Applicant
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Email
example@example.com
Should be Empty:

St. Vincent de Paul Casa Grande – Employment Application

Page 1 — Position and Personal Information

Page 2 — Employment History

Page 3 — References and Qualifications

Page 4 — Permission to Obtain Information

Page 5 — Confidential Background Information

Page 6 — Applicant Certification

Page 7 — Emergency Contact