Hour House: Employment Application Form

Employment Application Form:

Hour House Application for Employment
TO APPLICANT: We appreciate your interest in our organization. Thank you for taking time to complete this application. Federal and State Law prohibit discrimination in employment because of race, color, religion, sex, national origin, age, or physical handicap. Federal law also prohibits other types of discrimination such as citizenship, veteran status, attainment of benefits, and participation in union activities. State Law and local municipality ordinances also prohibit some or all of the above types of discrimination as well as some additional types including, but not limited to discrimination based upon ancestry, marital status or unfavorable discharge from military service. This list, however, is not exhaustive of the grounds on which discrimination is prohibited.
Personal:
Date

Month Day Year
Application Date
Full Name *

First Name Middle Name Last Name
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail
Are you legally eligible for employment in the U.S.A.?

Yes No
Are you over the age of 21?

Yes No (If no, hire is subject to verification that you are of minimum legal age to work.)
Have you been convicted of a major crime (felony) in the past 2 years? (Applicants are not obligated to disclose sealed or expunged records of conviction)

Yes (A conviction record will not necessarily bar employment.) No
Employment Position Desired:
Position (s) applied for?
Position (s)
Have You Previously Been Employed By Us? *

Yes No
If yes, when?
Date(s)
What Position Did You Previously Hold?
Supervisor's Name?
Pervious Supervisor's Name
If your application is considered favorably, on what date will you be available for work?
Date You Can Start

Month Day Year
May we telephone you to follow up this application? *

Yes No
If yes, what is the best time to call?

Morning Daytime Evening
May we telephone you to follow up on this application at work? *

Yes No
If yes, what is your business telephone number?
Current Employer Ph Number
Skills/Qualifications:
List any credentials you have that would assist in the job you are applying for?
List any relevant credentials
Are there any other job related experiences, skills, or qualifications which will be of special benefit in the job for which you are applying?
List any relevant experiences, skills, or qualifications
Education:
High School
Name & Address of High School Attended
Last Year Completed?
Last Year Completed
Graduated?

Yes No
College
Name & Address of College/University Attended
Last Year Completed?
Last Year Completed
Graduated?

Yes No
Degree
List Degree
Course of Study
List Course of Study
College or Graduate School
Name & Address of College or Graduate School Attended
Last Year Completed?
Last Year Completed
Graduated?

Yes No
Course of Study
List Course of Study
Degree
List Course of Study
Trade School/Other
Name of Trade/Technical/Other School Attended
Number of Years Attended
Graduated?

Yes No
Area of Study/Degree
Licensure or Certification
Name of Licensure or Certification
Skills
List any relevant skills
Qualifications
List any relevant certifications or qualifications
Employment History:

List present and past employment, beginning with your most recent
Current Employer
Name & Contact Information of Current Employer or NONE if not Employed
Position Held
Position Held
Duties/Responsibilities
Supervisor's Name
Supervisor's Name
Reason for Leaving?
Reason for Leaving
Start Date

Month Day Year
May We Contact?

Yes No
Previous Employment:
Previous Employer
Name & Contact Information of Previous Employer or NONE if n/a
Position Held
Name & Contact Information of Previous Employer or NONE if n/a
Duties/Responsibilities
Supervisor's Name
Supervisor's Name
Reason for Leaving?
Reason for Leaving
Start Date

Month Day Year
End Date

Month Day Year
May We Contact?

Yes No
Previous Employer
Name & Contact Information of Previous Employer or NONE if n/a
Position Held
Position Held
Duties/Responsibilities
Supervisor's Name
Supervisor's Name
Reason for Leaving?
Reason for Leaving
Start Date

Month Day Year
Date
End Date

Month Day Year
Date
May We Contact?

Yes No
Previous Employer
Name & Contact Information of Previous Employer or NONE if n/a
Position Held
Position Held
Duties/Responsibilities
Supervisor's Name
Supervisor's Name
Reason for Leaving?
Reason for Leaving
Start Date

Month Day Year
End Date

Month Day Year
May We Contact?

Yes No
I hereby give CEAD Council permission to contact the employers listed above concerning my prior work experience as indicated below. I hereby release CEAD Council and said employers from any liability in exchange of information concerning employment and work performance in the process of this reference inquiry.
Employer 1

Yes No
Employer 2

Yes No
Employer 3

Yes No
Employer 4

Yes No
Signature

Clear
Personal References:

(Not Former Employers or Relatives)
Reference 1
Name of Reference
How Do They Know You?
Phone
Contact Phone #
City/State
City/State
Reference 2
Name of Reference
How Do They Know You?
Phone
Contact Phone #
City/State
City/State
Reference 3
Name of Reference
How Do They Know You?
Phone
Contact Phone #
City/State
City/State
Cover Letter & Resume (Optional):
Cover Letter
Resume
Recruitment:
How did you hear about this position?

Indeed LinkedIn Facebook Jobs Org Website
Send Application:

PLEASE READ AND SIGN
The facts set forth in my application for employment are true and complete. I understand that if employed, any false statement on this application may result in my dismissal. I further understand that this application is not nor is it intended to be a contract of employment. This application does not obligate Hour House in any way if Hour House decides to employ me. I understand and agree that employment at Hour House is at-will and can be terminated by either party with or without notice at any time for any reason or no reason. No one other than the Executive Director of Hour House has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing and then only in writing signed by the Executive Director.
Signature of Applicant

Clear
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Employment Application Form:

Personal:

Employment Position Desired:

Skills/Qualifications:

Education:

Employment History:

Previous Employment:

Personal References:

Cover Letter & Resume (Optional):

Recruitment:

Send Application: