Employment Application

Employment Application

Thank you for your interest in employment with Children's Home of York. It is with the skill and dedication of our team members that we are able to continue providing the much-needed services to the children, youth, and families in your community! We are an equal opportunity employer.
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State

Zip Code
Phone Number *
E-mail *
example@example.com; we typically will contact you through email
Are you legally authorized to work in the United States? *

Yes No
How did you hear about this opportunity?
Name of Team Member
Employment Desired
Desired Position *
Desired Rate *
per hour
Approx. Annual Salary
Have You Worked Here Before? *

Yes No
Dates and position held
Type of employment desired (select all that apply)

Full Time Day Night Part Time Evening Weekend
Have you ever pled “guilty” or “no contest” to, or been convicted of, a crime? *

Yes No
If yes, provide dates and details
Answering “yes” does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.
Education
Highest Level of Schooling Completed *
If other, describe:
School Name
Type of Degree & Area of Study
Skills/Qualifications
Summarize any special training, skills, licenses and/or certifications that may assist you in performing the position for which you are applying. Provide license numbers, if applicable.
List any relevant skills
Employment History
Most Recent Employer *
Position *
Address *

Address

Address 2

City State

Zip Code
Phone Number *
Supervisor Name *
Start Date *
End Date
May We Contact? *

Yes No Later
Reason for Leaving? *
Previous Employer
Name of Previous Employer
Position
Address

Street Address

Street Address Line 2

City State

Zip Code
Phone Number
Supervisor
Start Date
End Date
May We Contact?

Yes No Later
Reason for Leaving?
Previous Employer
Name of Previous Employer
Position
Address

Street Address

Street Address Line 2

City State

Zip Code
Phone Number
Supervisor
Start Date
End Date
May We Contact?

Yes No Later
Reason for Leaving?
References

We require three references, two of which must have a supervisory relationship with you. *Email contact is preferred and makes the employment process faster for you*
Reference 1 *
Name of Reference
Years Acquainted *
Relationship to you *
Supervisor is preferred
Provide relationship
Email *
if none, enter none@noreply.com
Phone *
Reference 2 *
Name of Reference
Years Acquainted *
Relationship to you *
Supervisor is preferred
Provide relationship
Email *
if none, enter none@noreply.com
Phone *
Reference 3 *
Name of Reference
Years Acquainted *
Relationship to you *
Supervisor is preferred
Provide relationship
Email *
if none, enter none@noreply.com
Phone *
Cover Letter & Resume (Optional)
Cover Letter
.pdf/.docx
Resume
.pdf/.docx
Certification
I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.

I expressly authorize, without reservation, the employer, its representative, employees or agents to contact and obtain information from all references, personal and professional, employers, public agencies, licensing authorities and education instructions and to otherwise verify the accuracy of all information provided by me in this application, résumé or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.

I understand that this application remains current for one year. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and full out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing expressed language are valid unless they are in writing and signed by the employer’s president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration law require me to complete and I-9 Form in this regard.

This organization does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under applicable federal, state or local law.

I understand that any information provided by me that is found to be false, incomplete or misrepresent in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer’s service, whenever it is discovered.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
Signature of Applicant *

By submitting the following, you agree your electronic signature is the legal equivalent of your manual signature on this document. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or in accessing or making any transaction regarding any document, acknowledgment, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and document as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting agreement between you and Children's Home of York. Clear
Today's Date *

Month Day Year
AN EQUAL OPPORTUNITY EMPLOYER
Should be Empty:

Employment Application

Employment Desired

Education

Skills/Qualifications

Employment History

References

Cover Letter & Resume (Optional)

Certification