| Full Name (First, Middle, Last): |
|
| Address (street, city, state, zip code): |
|
| County of Residence |
|
| Contact Phone: |
|
| Alternate Phone: |
|
| Email Address: |
|
| Valid Ohio Driver's License? |
Yes
No
|
| Legal Right to Work in the USA? |
Yes
No
|
| What job position are you applying for? |
|
| How did you hear about this open position? |
|
| Do you have any physical limitations or driving restrictions that will
prevent you from carrying out the general duties of the position that you are applying
for? |
Yes
No
|
| What type of job are you looking for? (check all that apply) |
Full-Time (40 hours/week)
Part-Time (greater than 26 hours/week)
Part-Time (less than 26 hours/week)
Casual
Temporary
Contract
|
| Shifts you will accept(check all that apply): |
Day
Evening
Nights
Rotating
Weekends
As Needed
|
| List all shift, day or hour restrictions: |
|
| High School name and location: |
|
| Year Completed: |
9th
10th
11th
12th
|
| Did you graduate high school? |
Yes
No
|
| Did you obtain a GED? |
Yes
No
|
| College/University and Location: |
|
| Check year completed: |
1
2
3
4
5
6 or more
|
| Did you graduate? |
Yes
No
|
| If yes, specify year of graduation, degree and major: |
|
| College/University and Location: |
|
| Check year completed: |
1
2
3
4
5
6 or more
|
| Did you graduate? |
Yes
No
|
| If yes, specify year of graduation, degree and major: |
|
| College/University and Location: |
|
| Check year completed: |
1
2
3
4
5
6 or more
|
| Did you graduate? |
Yes
No
|
| If yes, specify year of graduation, degree and major: |
|
| Dates (From/To): |
|
| Employer: |
|
| Position/Title: |
|
| Address (address, city, state, zip code): |
|
| Telephone Number: |
|
| Supervisor: |
|
| Hours per week: |
|
| Salary/Wage: |
|
| May we contact this employer? |
Yes
No
|
| Reason for leaving: |
|
| Dates (From/To): |
|
| Employer: |
|
| Position/Title: |
|
| Address (address, city, state, zip code): |
|
| Telephone Number: |
|
| Supervisor: |
|
| Hours per week: |
|
| Salary/Wage: |
|
| May we contact this employer? |
Yes
No
|
| Reason for leaving: |
|
| Dates (From/To): |
|
| Employer: |
|
| Position/Title: |
|
| Address (address, city, state, zip code): |
|
| Telephone Number: |
|
| Supervisor: |
|
| Hours per week: |
|
| Salary/Wage: |
|
| May we contact this employer? |
Yes
No
|
| Reason for leaving: |
|
| List all certificates and licenses (include issuing agency and license
number) |
|
| SUMMARY OF QUALIFICATIONS: Briefly describe the experience, education,
training and other factors that qualify you for the position for which you are
applying: |
|
| Have you ever been convicted of a felony (A felony conviction may not
automatically disqualify you for the position): |
Yes
No
|
| If you answered YES to having been convicted of a felony, please give
date(s) of conviction(s) and explain: |
|
| List three references (at least one professional), not related to you, who
have known you for more than one year. Include name, contact number(s), address and/or email
address: |
|
| I certify that all information provided by me on this application is true
and complete to the best of my knowledge and that I have withheld nothing that, if disclosed,
would alter the integrity of this application. |
Yes
No
|
| I authorize my previous employers or persons listed as references to give
any information. I agree that House of New Hope and my previous employers will not be held
liable in any respect if a job offer is not extended, or is withdrawn, or employment is
terminated because of false statements, omissions, or answers made by myself on this
application. |
Yes
No
|
| In compliance with the Immigration Reform and Control Act of 1986, I
understand that I am required to provide approved documentation to the company that verifies my
right to work in the United States on the first day of employment. |
Yes
No
|
|
