Please answer the following to the best of your ability. Please ask if you require assistance in filling out this application form or in any other phase of the application process so that we may accommodate your needs.
Your Full Name:
Address:
City, State and Zip Code:
Home Phone:
Work Phone:
Cell Phone:
Email Address:
Position Desired (what would you like to do with us - child care, housekeeping, teaching, cooking, etc.):
Are you over 16 years of age? Yes No
How were you referred?
Start date available:
Are you able to work all shifts? Yes No
If NO, when are you unable to work?
Are you a U.S. citizen or authorized to work legally in the United States? Yes No
Conviction Information An applicant with a sealed record of entries on file with the commissioner of probation may answer "no record" to an inquiry about prior convictions of a crime. In addition, any applicant for employment may answer "no record" to an inquiry relative to all cases of delinquency or as a "child-in-need-of-services" for which no criminal prosecution resulted.
Have you ever been convicted of a felony? Yes No
If YES, explain:
Have you been convicted of a misdemeanor within the past 5 years? (Do not include a first conviction for drunkenness, simple assault, speeding, minor traffic violations, affray or disturbance of the peace.) ?
Yes No If YES, explain:
Military Service:Branch:
Rank:
Discharge Date:
Training or Type of Work Done in Military Service:
Schooling: *Dates Attended High School City & State Course Degree *Dates Attended Trade/Technical School City & State Course Degree *Dates Attended College City & State Course Degree *Dates Attended Other Courses or /Schooling City & State Course Degree Professional or Technical Licenses (for each list state and date): Please describe any job-related skills or training not mentioned above:
Work History List present or most recent job first. Include all employment. You may include in your work history any work performed on a volunteer basis.
JOB 1:
Dates
Company Name/Address
Job Titles/Duties
Weekly Pay
Reason for Leaving
Are you on layoff and subject to recall? Yes No
*Are you known to schools/references (prior employers) by another name? Yes No
If YES, what name?
* Information sought solely to facilitate reference & background checks.
Post Employment Please answer the following questions. * What was your most significant accomplishment at work?
* What did you learn from that success?
* What was the best thing you did at your present job that made an impact on the organization?
* Describe the relationship you have with your current boss.
* What kind of supervision did you have?
* How would you change that level of supervision to increase your effectiveness?
* What frustrates you about your current job?
* What do you like doing the most in your present job?
* If you could do anything in the world and money wasn't an object, what kind of work would you do?
* What was the most challenging task that you have completed?
* What would your boss tell me about your performance?
* Why do you want to leave your current job?
* What motivates you?
* What are your career goals?
* Why do you think you will successful in your job?
* Tell me about the best boss you've had.
* Tell me about the worst boss you've had.
* If I were to call five people who knew you well, what would be three words they would use to describe you?
* Why do you want this job?
* What is it about this job that gets you excited?
* If you were in my chair, hiring someone for this position, what qualities would you look for in the applicant?
* On your last job, what did you do to improve your effectiveness?
* If we were meeting here three years from today - and you were to look back over those years to today, what has to have happened during that period, both personally and professionally, for you to feel happy about your progress?
In case of emergency notify (insert name of person): Address/Phone
Please Read Carefully and Sign the Statement Below:I certify that the information given above is true and complete and I understand that misrepresentation and/or withholding of information will result in the rejection of this application or my discharge if discovered after employment begins.
The Company, in considering my application for employment, may verify the information set forth on this application and obtain additional information relating to my background, including my motor vehicle driving record. I authorize all persons, schools, prior employers, credit bureaus, law enforcement agencies and Registry of Motor Vehicles to supply any information concerning my background. I hereby release such persons, schools, prior employers, credit bureaus, law enforcement agencies, Registry of Motor Vehicles or other individuals from all liability in responding to inquiries in connection with my application and release the Company from all liability with respect to such inquiries.
I understand that this application shall be considered valid only for thirty (30) days from today's date. If I still desire a position with the Company after this thirty (30) day period expires, it will be my responsibility to fill out a new application and file it with the Company. Otherwise, the Company will not consider me for employment after this application expires.
I understand that if employed, I will be an employee "at will" and may be terminated at any time, with or without cause, and with or without notice at the option of either the Company or myself. If I am employed, I agree to abide by the Company's policies, rules and procedures and any changes thereto.
Applicant's Signature: By filling in your name below you are electronically signing this document.
Date
NOTE: BEFORE PRESSING THE "SUBMIT" BUTTON PLEASE PRINT OUT YOUR APPLICATION IN CASE THERE ARE ANY INTERNET ISSUES WHICH RESULT IN PROBLEMS. By pressing SUBMIT, you are further acknowledging everything listed above is correct. Please press SUBMIT only once. It may take a few seconds to process your application. Once submitted, you will be taken to a page with further instructions.