Application for Employment

Date:
Name:
Last First Middle
Address:
Number & Street City State Zip Code
Home Phone: / Cell Phone: / Email Address:
How did you hear
about us?
Are you at least
18 years of age? / YES NO / Are you looking for: FULL TIME PART TIME EITHER
What position are you applying for? / When can you start?
Are you currently employed? / YES NO / Present Position
If employed, may we contact your present employer? / YES NO
Please list any relatives or friends
who work for The Point:
Have you previously
worked for The Point? / YES NO / If yes, please provide dates and location
CRIMINAL HISTORY
Have you ever been convicted of a crime? / YES NO
If yes, please explain:
EDUCATION
Name of School / Years Attended / Course of Study / Did you Graduate? / Degree

EMPLOYMENT HISTORY

1. Employer Name & Address:Phone Number:Dates: To & From:

Position Held:Supervisor/Contact:Reason for Leaving:

2. Employer Name & Address:Phone Number:Dates: To & From:

Position Held:Supervisor/Contact:Reason for Leaving:

3. Employer Name & Address:Phone Number:Dates: To & From:

Position Held:Supervisor/Contact:Reason for Leaving:

4. Employer Name & Address:Phone Number:Dates: To & From:

Position Held:Supervisor/Contact:Reason for Leaving:

REFERENCES

Please list three individuals for whom you have worked for or who have knowledge of your work performance (other than family).

Name & Address / Relationship to You / Years Known / Phone Number

WHAT SPECIFICALLY INTERESTS YOU ABOUT THIS POSITION?

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EEO Policy:

The Point maintains a policy of non-discrimination for all employees and applicants in every facet of the company’s operations. In compliance with federal and state laws, The Point hires, trains, and promotes all qualified employees without unlawful discrimination on the basis of race,color, sex, gender identity, sexual orientation, pregnancy, age, religion, citizenship, national origin, disability, or genetic information.

Certifications:

I understand and agree that this application is not a contract and does not guarantee that I will be considered further in the hiring process or given an offer of employment. I also understand that if hired by The Point, my acceptance of any offer of employment is on an at-will basis.

I also certify that the information furnished in this application and any supporting documents is true and complete to the best of my knowledge and belief, and I understand that any misrepresentation or omission of material fact on this or any other record submitted pertinent to employment will constitute grounds for immediate dismissal.

I certify that I have read, understand, and will adhere to the statements above.

Applicant’s Signature ______Date ______

THE POINT/ARC OF NORTHERN KENTUCKY

104 WEST PIKE STREET

COVINGTON, KENTUCKY 41011

PHONE 859.491.9191FAX 859.491.0763

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