Application for Employment

Application for Employment
El Hogar Community Services, Inc.
As part of the routine recruiting process, El Hogar Community Services, Inc. routinely verifies all information provided

on the Applications for Employment. Therefore, you should take the time and attention necessary to ensure that all information provided on this Application for Employment is complete and accurate.

El Hogar Community Services, Inc. considers itself to be an Equal Opportunity Employer. Offers of employment are

extended only to those candidates that have successfully passed our pre-employment screening processes.

Each applicant should understand that all information provided on this application for employment is provided voluntarily by the candidate and may be used by the prospective employer in any manner the prospective employer deems appropriate in making an employment offer determination, or in future needs as may be provided by Company policy, or as required by State and Federal law. By completing this application for employment, the applicant authorizes this employer to conduct any form of verification(s) it deems appropriate to verify the information provided on this application. It is important to understand that El Hogar Community Services, Inc. cannot have situations of a dual relationship with anyone selected for employment. As such, any applicant who is currently receiving services from any of the El Hogar programs will be required to transition their services to an agency other than El Hogar at the time of employment.
Applicant’s Name
Date

MonthDayYear
Date
List other names you use or have used, including maiden names, nicknames, stage names, married
names.
Address

Address

Street Address Line 2

CityState

Zip
Telephone #
Cell Phone #
Email Address
example@example.com
Yes

Is it OK to leave a message on either of these phone numbers?No
What position are you applying?
Type of employment desired

full-timepart-timetemporary
Date you will be available to start work

MonthDayYear
Date
Driver's License
Issuing State
Expiration date

MonthDayYear
Date
Are you able to provide proof of a clean DMV report?

Are you able to meet regular attendance requirements?

Are you able to work overtime if necessary?

Can you perform the essential functions of the job with or
If hired, can you show proof that you may legally work in the USA?

YesYesYesYesYes
If hired, can you show proof that you may legally work in the USA?

NoNoNoNoNo
How did you hear about this job opportunity?
Application for Employment El Hogar Community Services, Inc.
Employment History
Please provide all employment information for the past seven years employment starting with the most recent. You may use another sheet if necessary.
May we contact your current and past employers?

YesNo
Employer
Position held
Address
Telephone #
Immediate manager and title
Dates employed: from

MonthDayYear
Date
to
Job summary
Reason for leaving
Employer
Position held
Telephone #
Telephone #
Immediate manager and title
Dates employed: from

MonthDayYear
Date
to
Job summary
Reason for leaving
Position held
Position held
Address
Telephone #
Immediate manager and title
Dates employed: from

MonthDayYear
Date
to
Job summary
Reason for leaving
Other Skills and Qualifications
Summarize any job-related training, skills, licenses, certificates, and/or other qualifications:
Educational History
List school name and location, number of years completed, course of study, and any degrees earned:
Yes

Do you have a High school Diploma or GED?No
Name of high school

AA/ASBA/BSMA/MSPh.DList school name and location, number of years completed, course of study, and any degrees earned:
Name of high school
Name of high school
Do you have an Associates, Bachelor or Master Degree?
M.D.

Psy.D
Name of college/s and dates of attendance

MonthDayYear
Date
Name of college/s and dates of attendance:
Revised 05/2022 Page 2 of 4
Application for Employment El Hogar Community Services, Inc.
Yes

Do you have a technical or vocational Certification?No
If yes, what is the name of the certification
Name of technical/vocation School and dates of attendance

MonthDayYear
Date
Are you licensed or certificated in a particular discipline? If yes, please provide the name of license
and/or certification and expiration date (if applicable)

MonthDayYear
Date
and/or certification and expiration date (if applicable)

MonthDayYear
Date
References
Please list 2 professional and 1 personal references who can comment on your qualification for

the position for which you have applied:
Phone
Years Known
Years Known
Relationship to this person
Name
Years Known
Years Known
Relationship to this person
Name
Years Known
Years Known
Relationship to this person
Why do you feel that you are the best possible candidate for this position?
Why do you feel that you are the best possible candidate for this position?
I hereby authorize El Hogar Community Services, Inc. to verify the accuracy of information contained in this application for all previous employers, educational institutions, and references. I hereby release all prior employers, and references provided from liability in conjunction with providing verification of information to El Hogar Community Services, Inc. I understand that any misrepresentation or material omission made by me will result in disqualification for employment, or once employed, be grounds for immediate termination of my employment. I understand that El Hogar Community Services, Inc. is not able to have a dual relationship with any person selected for employment. As such, I understand that should I currently be receiving services from any El Hogar program, I will need to transition services to another agency other than El Hogar at the time I am selected for employment, if selected. I also understand that any offers of employment are made as employment At-Will and as such, are subject to termination by either the company or myself at any time, with or without prior notice. I understand that it is the policy of El Hogar Community Services, Inc. not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that persons need for a reasonable accommodation as required by the ADA.
Application for Employment El Hogar Community Services, Inc.

I understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three business days of being hired. I understand failure to submit such proof within the required time, or failure to comply with any pre-employment requirement may result in the offer of employment being rescinded, or employment termination. I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.
Applicant Signature
Date

MonthDayYear
Date
Should be Empty:

Application for Employment

Employment History

Other Skills and Qualifications

Educational History

References