Employment Application Form

Douglass Community Association
Personal Information:
Full Name*

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Position applying for?
Desired Salary?
When can you start?
Have you ever worked for DCA before?

YesNo
If yes when?
Are You a U.S. Citizen?

YesNo
Are you authorized to work in the United States?

YesNo
EDUCATION
High School
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From:
To:
Did you graduate?

YesNo
Degree
College
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From
To
Did you graduate?

YesNo
Degree
School
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From
To
Did you graduate?

YesNo
Degree
REFERENCES

Please list three professional references.
Name

First NameLast Name
Relationship
Company
Phone Number

Area CodePhone Number
Name

First NameLast Name
Relationship
Company
Phone Number

Area CodePhone Number
Name

First NameLast Name
Relationship
Company
Phone Number

Area CodePhone Number
PREVIOUS EMPLOYMENT
Company
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?

YesNo
Company
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?

YesNo
Company
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?

YesNo
MILITARY SERVICE
Branch
From
To
Rank at Discharge
Type of Discharge
If other than honorable, explain
CRIMINAL HISTORY (All applicants must agree to a criminal background check)
Have you ever been convicted of criminal sexual conduct?

YesNo
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my immediate termination.
Signature

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Date

MonthDayYear
Date
Should be Empty:

Douglass Community Association

Personal Information: