Employment Application – Our House, Inc.

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Cell Phone

Social Security Number (voluntary)

Position(s) Applied For:

Best Time to Contact you at home is:

AM
PM

If you are under 18 years of age, can you provide required proof of your eligibility to work?

YES
NO

Have you ever filed an application out with us before?

YES
NO

If yes , please give date

Have you ever been employed with us before?

YES
NO

If yes, please give date

Do any of your friends or relatives, other than spouse, work here?

YES
NO

If yes, state name, relationship and location

Are you currently employed?

YES
NO

May we contact your present employer?

YES
NO

Are you prevented from lawfully becoming employed in this Coutry because of Visa or Immigration Status?

YES
NO

Proof of citizenship or immigration status will be required upon employment

Date available to start

What is your salary range?

Are you available to work:

Full Time
Part Time
Temporary

For full time employment please indicate shift

First
Second
Third

For part time employment please indicate

Mornings
Afternoon
Evenings

For temporary employment please indicate dates available

Are you currently on "lay-off' status or subject to recall?

YES
NO

Can you travel if a job requires it?

YES
NO

EDUCATION

High School

High School Address

Address Line 1

Address Line 2

City

State

Zip Code

Did you graduate high school?

YES
NO

Number of years completed

Did you attend college?

YES
NO

College

College Address

Address Line 1

Address Line 2

City

State

Zip Code

Did you graduate college?

YES
NO

Number of years toward diploma

What was your degree?

Did you have any other training?

YES
NO

Additional Training School Name

Additional Training Address

Address Line 1

Address Line 2

City

State

Zip Code

WORK EXPERIENCE

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer: 1

Dates Employed (Employer: 1)

Work Performed (Employer: 1)

Address (Employer: 1)

Address Line 1

Address Line 2

City

State

Zip Code

Phone (Employer: 1)

Hourly Rate/Salary (Employer: 1)

Reason for Leaving (Employer: 1)

Include explanation of any gaps in employment

Add a Second Employer

YES
NO

Employer: 2

Dates Employed (Employer: 2)

Work Performed (Employer: 2)

Address (Employer: 2)

Address Line 1

Address Line 2

City

State

Zip Code

Phone (Employer: 2)

Hourly Rate/Salary (Employer: 2)

Reason for Leaving (Employer: 2)

Include explanation of any gaps in employment

Add a Third Employer

YES
NO

Employer: 3

Dates Employed (Employer: 3)

Work Performed (Employer: 3)

Address (Employer: 3)

Address Line 1

Address Line 2

City

State

Zip Code

Hourly Rate/Salary (Employer: 3)

Reason for Leaving (Employer: 3)

Include explanation of any gaps in employment

Describe any specialized training, apprenticeship, skills and extra-curricular activities

Describe any job-related training received in the United States Military

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

Additional Information Other Qualification Summarize special job-related skills and qualifications from employment or other experience

Specialized Skills (Skills/Equipment Operated) List of Computer Programs You Are Production/Mobile Other (list) Familiar with Machinery (list)

State any additional information you feel may be helpful to us in considering your application

Note to Applicant: 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

Personal/Professional References Do not include family members or past supervisors.

First

Last

References' Phone

Best Time to Call Reference

Reference Occupation

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 herby understand and acknowledge that, unless otherwise defined by applicable law, and employment relationship with this organization of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time 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.

I agree

YES
NO

APPLICATION FOR EMPLOYMENT

EDUCATION

WORK EXPERIENCE

APPLICANT'S STATEMENT