Employment

EMPLOYMENT APPLICATION

PART 1: APPLICATION INFORMATION

Position Applied for

How did you learn about us?
Other:

PART 2: CONTACT INFORMATION

Prefix
First Name
Middle Initial/Name
Last Name
Suffix
Degrees
Title
Prog/Org/Instit.
Address
Address
City/State/Zip
Phone
Phone
Fax
E-mail
		You will receive an e-mail confirmation at this address.

Would you like to sign up to receive e-mail news from Casa Esperanza?
Yes No

Social Security Number
Best time to contact you at home

PART 3: EMPLOYMENT INFORMATION

A) If you are under 18 years of age, can you provide required proof of eligibility to work?		Yes No
B) Have you ever filed an application with us before?		Yes No
If yes, give date
C) Have you ever been employed with us before?		Yes No
If yes, give date
D) Do any of your friends, relatives, other than spouse, work here?		Yes No
E) Are you currently employed?		Yes No
F) May we contact your present employer?		Yes No
G) Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status? Proof of citizenship or immigration status will be required upon employment.		Yes No
H) Date available for work
I) What is your desired salary range?
J) Are you available to work:
Full-Time (indicate shift) 1 2 3
Part-Time (indicate shift) Mornings Afternoons Evenings
Temporary (indicate dates available) to

K) Are you currently on "lay-off" status and subject to recall?		Yes No
L) Can you travel if a job requires it?		Yes No

PART 4: EDUCATION

A)
Elementary School
Name & Address of School
Course of Study
Years Completed
Diploma Degree

High School
Name & Address of School
Course of Study
Years Completed
Diploma Degree

Undergraduate College
Name & Address of School
Course of Study
Years Completed
Diploma Degree

Graduate Professional
Name & Address of School
Course of Study
Years Completed
Diploma Degree

Other (specify)
Name & Address of School
Course of Study
Years Completed
Diploma Degree


B) Describe any specialized training, apprenticeship, skills, and extra curricular activities.

C) Describe any job-related training received in the United States military.

PART 5: EMPLOYMENT EXPERIENCE

A)
Employer
Address
Phone Number
Job Title
Supervisor
Dates Employed		to
Hourly Rate/Salary		Starting Final
Work Performed
Reason for Leaving

Employer
Address
Phone Number
Job Title
Supervisor
Dates Employed		to
Hourly Rate/Salary		Starting Final
Work Performed
Reason for Leaving

Employer
Address
Phone Number
Job Title
Supervisor
Dates Employed		to
Hourly Rate/Salary		Starting Final
Work Performed
Reason for Leaving

Employer
Address
Phone Number
Job Title
Supervisor
Dates Employed		to
Hourly Rate/Salary		Starting Final
Work Performed
Reason for Leaving

B) List professional, trade, business or civic activities and offices held. You may exlude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status.

PART 6: ADDITIONAL INFORMATION

A) Other Qualifications - Summarize special job-related skills and qualifications acquired from employment or other experience.

B) Specialized Skills - Check skills/equipment operated
Terminal
Spreadsheet
Typewriter		WPM
Shorthand		WPM
PC/Mac
Word Processing
Production/Mobile Machinery (list)

Other (list)

C) Other relevant information - State any additional information you feel may be helpful to us in considering your application.

D) Performance Capability - Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given.

Yes No Have not been informed about requirements.

PART 7: REFERENCES

Name
Address
Phone

Name
Address
Phone

Name
Address
Phone

PART 8: APPLICANT'S STATEMENT

I certify that answers given herein are true and complete. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

By typing your full name and submitting this form, you are stating that you agree to the terms and conditions above.
Signature of Applicant
Date		02/05/2012

PART 9: COVER LETTER & RESUME UPLOAD If you have a cover letter and resume, you will be asked to upload them on the next screen. Your documents must be in Microsoft Word or PDF format.
Microsoft Word PDF Document

		You will be asked to review your application on the next page before your submission is complete.