Washington Metropolitan Inc. dba Safe Spaces Application

Thank you for your interest in our organization. Please take a minute to complete the application.

Position you are applying for: *
Position for which you are applying *

Personal Information
Full Name *

First Name Middle Name Last Name
Phone Number *

Area Code Phone Number
Home Phone Number
Work Phone Number
Cell Phone Number
Email Address
High School Name *
Years Attended *
Graduated? *

Yes No
Degree / Major
College Name
Years Attended
Graduated?

Yes No
Degree / Major
Trade or Correspondence School
Years Attended
Graduated?

Yes No
Degree / Major

Employment Experience

Please list current/previous job experience you have, including dates, employer name address and phone number, position, salary, supervisor's name and phone number, and reason for leaving.

Start with the most recent first.
Most recent position *
Second most recent position
Third most recent position
Fourth most recent position
Please explain any gaps in employment
Other Relevant Experience

Please list any other experience you have, including dates, employer name address and phone number, position, salary, supervisor's name and phone number, and reason for leaving.
Experience #1
Experience #2
Experience #3

List of References:

Please list four individuals who are very familiar with your professional work and character who may be contacted. Please include their name, position, business phone, home or cell phone, and address.
References
In the field below, please respond to each of the following questions:

1. Why are you applying for this position?

2. What experience do you have specific to the position you are applying for and how would you use that experience to be a successful in the program?
Narrative Response
List degrees, honors, commendations, elective or appointive offices held, or other distinctions received.
HONORS AND DISTINCTIONS

AGREEMENT (Read carefully before signing or submitting electronically)

By my signature:

• I acknowledge that individuals who provide false, inaccurate, or incomplete information in the application form, in an interview, or any other part of the hiring process or who fail to disclose information requested in the application form, in an interview, or any other part of the hiring process will not be eligible for employment, or, if they are hired, they will be subject to termination.

• I acknowledge that to the fullest extent permitted by state and federal law, the hiring party will consider all information concerning an applicant or an employee in making hiring, termination, and other employment-related decisions. The term "all information" includes information of any kind (verbal, written, photographic, videographic, etc.) that is accessible in any medium (print, electronic, etc.) from any source.

• I acknowledge that the hiring party will consider public information and other information to which it has lawful access. This may include information that is contained in social networking sites, blogs, and other electronic sites, such as YouTube. If there is information that pertains to me that I believe requires explanation, interpretation, or clarification when it is considered, it is my obligation to communicate this information to the hiring employer.

• I authorize the hiring party to conduct a complete check regarding my background including, but not limited to, criminal record, child and dependent adult abuse registry screening, and sex offender registry. I agree to prepare and sign any other form necessary to complete a criminal background check. I further authorize all government agencies departments, bureaus, or related entities to release any and all information regarding my criminal history, if any. I agree to immediately notify the hiring party if I should be convicted of any crime while my application is pending, or during my period of employment, if hired.

• I authorize all current and former employers, teachers, and references to release all information regarding my professional competence, performance, character, and background. I waive any right I may have against any person contacted as a reference concerning this application.

• I acknowledge that information that is relevant to the hiring party's decisions will be considered regardless of the date on which the hiring party obtains the information and regardless of the date on which the information was first published, created, or made accessible to the hiring party.

• I understand that this application will be considered active for twelve (12) months from the date filed. I further understand this information will become part of my permanent record.

• I understand that this application is not a contract of employment. In accepting the position, if hired, I understand that employment is at will, unless otherwise specified. I acknowledge that the hiring party may discharge an at-will employee at any time for any legal reason or no reason at all.

• I agree to submit to both pre-employment and post-employment random drug and alcohol testing.
By my electronic submission of this form:

• I attest that all the information contained in this application is accurate, complete, and true.

• I am bound by all elements of the agreement section of the application.

• I understand and accept that electronic submission will be considered equivalent to an original hand written signature on a paper copy of the application.
Cover Letter *

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Resume *

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E-signature *
Print Name
Date *
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