|
APPLICATION FOR EMPLOYMENT Date of Application:___________ Name:_______________________________________________________ Address:_____________________________________________________ City:_______________________________ State:____ Zip:____________ Home Phone:______ Work Phone:______ Soc. Security #:____________ Position Applying For: ________ Business/Secretarial ________ Social Work ________ Child Care Worker ________ Maintenance/Carpentry ________ Farm/Ranch ________ Other:______________________________ Employment Condition: ________ Part Time, Permanent ________ Seasonal/Temporary ________ Other:_______________________________ Are there times which you would not be available to work? ____________________________________________________________ Have you ever applied at Home On The Range before? ___Yes ___ No If yes, when?_________________________________________________ Have you ever been convicted of a crime? ___ Yes ___ No If yes, explain:________________________________________________ EDUCATION List school attended, dates enrolled, major/minor: ____ Graduate School__________________________________________ ____ College/University_________________________________________ ____ Vocational_______________________________________________ ____ High School______________________________________________ Degrees Earned:_______________________________________________ ____________________________________________________________ EMPLOYMENT HISTORY List current employer first. May we contact your present employer? ___Yes ___ No Employer:____________________________________________________________________ Address:_____________________________________________________________________ Length of Employment: Started _____________________ to _________________________ Title:______________________________ Hours/Week:________ Salary:________________ Specific Duties:________________________________________________________________ Supervisor:____________________________ Phone #:________________________________ Reason for leaving:_____________________________________________________________ ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ Address:_____________________________________________________________________ Length of Employment: Started _______________________ to _________________________ Title:_______________________________ Hours/Week:________ Salary:________________ Specific Duties:________________________________________________________________ Supervisor:____________________________ Phone #:________________________________ Reason for leaving:_____________________________________________________________ ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ List any volunteer or unpaid work experiences you have had:____________ ____________________________________________________________ Are you willing to do shift work? _____ Yes _____ No Have you served in the military? _____ Yes _____ No List any special training received while in the service:_________________ ____________________________________________________________ Do you qualify for and have a valid drivers license? _____ Yes _____ No If no, explain:_________________________________________________ Do you know any of the Home On The Range staff? _____ Yes _____ No If yes, who?__________________________________________________ What would you like to be doing five years from now? _____ Child Care _____ Social Work _____ Administration _____ Other:________________________________________ What traits do you possess that would make you a productive member of the Home On The Range staff?_______________________________________ ____________________________________________________________ What do you consider to be your weak points in working with children and others? ______________________________________________________ ____________________________________________________________ What prompted you to apply at Home On The Range? ____________________________________________________________ ____________________________________________________________ Home On The Range accepts children of all races, creeds and colors and employs staff without regard to their race, color, sex, age, religion, national origin or handicapped status. As a prospective employee, do you have any prejudices that would affect the way you treat the children placed here or the people you could possibly be working with? ___________________________ ______________________________________________________________________________ In case of a medical emergency, who should be notified? Name:_______________________________________ Relationship:____________________ Address:_________________________________City:___________________ State:_______ Phone:___________________________________ REFERENCES Please list three people, other than relatives, who will accurately attest to your working abilities. Name:_____________________________________ Occupation:________________________ Address:_______________________________ City:______________________ State:______ Phone #:_______________________________ ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ Name:_____________________________________ Occupation:________________________ Address:_______________________________ City:______________________ State:______ Phone #:_______________________________ ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ Name:_____________________________________ Occupation:________________________ Address:_______________________________ City:______________________ State:______ Phone #:_______________________________ ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ I hereby certify that all information on this application is true, correct and complete to the best of my knowledge and contains no willful falsifications or misrepresentations. I am aware that falsifications or misrepresentations may disqualify me from consideration from this and future positions of employment or, if hired, may be grounds for termination at a later date. UNSIGNED OR INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED. Signature:____________________________________________ Date:___________________ -An Equal Opportunity Employer-
|