24:1 Community Land Trust

EMPLOYMENT APPLICATION

24:1 Community Land Trust.isanequalopportunity/affirmativeactionemployer.Allqualifiedapplicantswillbeconsideredwithoutregardtoage,race,color,sex, religion,nationalorigin,maritalstatus,ancestry,citizenship, veteranstatus,sexualorientationorpreference,orphysicalormentaldisability.

Personal

LastNameFirstInitialEmail Address:______

Other Name(s)UsedHome Telephone# ()

AddressCellphone# ()

______

City State Zip Code

Position AppliedForReferredBySalary Desired

Haveyou everinterviewedwith the Company orits
affiliatesbefore?□Yes□ No / Ifyes, listdate(s),job title(s)location(s)
Haveyou everbeen employed by the Company orits
affiliatesbefore?□Yes□No / Ifyes, listdate(s),job title(s)location(s)
Do you have any relativesemployed bythe Company or
its affiliates? □Yes □ No / Ifyes, listdate(s),job title(s)location(s)
Areyou at least18 yearsold?□Yes□No / Ifunder 18, doyou haveaworkpermit?

Education

CircleHighestGrade Completed: / High School / 9 / 10 / 11 / 12
College, Trade orBusiness / 1 / 2 / 3 / 4
GraduateStudies
School / Address / MajorStudies / GED, Diploma or College Degree
High School
College/University
Graduate School
Vocational School (including any License or Certificate)
List Any Professional Designations or Certifications
Other Special Knowledge, Skills or Qualifications

EmploymentHistory

Listallemploymentforthepast10years,startingwiththemostrecentposition.All informationmustbecompleted.Youmayattacharesume,butnotinplaceofcompleting therequiredinformation.

EmployedFrom
/ / EmployerName / SupervisorName / Starting Salary
Employed Until
/ / EmployerAddress / SupervisorPhone # / Ending Salary
Job Title / Reasonfor Leaving
Dutiesand Responsibilities
EmployedFrom
/ / EmployerName / SupervisorName / Starting Salary
Employed Until
/ / EmployerAddress / SupervisorPhone # / Ending Salary
Job Title / Reasonfor Leaving
Dutiesand Responsibilities
EmployedFrom
/ / EmployerName / SupervisorName / Starting Salary
Employed Until
/ / EmployerAddress / SupervisorPhone # / Ending Salary
Job Title / Reasonfor Leaving
Dutiesand Responsibilities
EmployedFrom
/ / EmployerName / SupervisorName / Starting Salary
Employed Until
/ / EmployerAddress / SupervisorPhone # / Ending Salary
Job Title / Reasonfor Leaving
Dutiesand Responsibilities

General

Yes / No
□ / □ / Maywe contactyour currentemployerforreferences?
□ / □ / Ifhired,willyou beable towork overtime?
□ / □ / Willyou be able to perform the essential jobfunctionsfor theposition you areapplyingfor with orwithoutreasonable accommodation?

CertificationAuthorization

The aboveinformation istrue andcorrect. I understand that,in theeventofmy employmentbythe Company, Ishallbesubject todismissal ifanyinformationthatI havegiven in thisapplicationisfalseor misleading or ifI havefailed to give anyinformation herein requested, regardless of thetimeelapsed after discovery.

I authorize the Companyto inquireinto my educational, professionaland pastemploymenthistory referencesas needed toresearchmy qualificationfor this position.I hereby give myconsentto anyformer employerto provide employment-relatedinformation aboutmeto the Company andwillhold the Company andmyformeremployerharmlessfromany claim made onthe basisthatsuchinformation aboutmewas provided orthat any employmentdecisionwasmade onthe basis ofsuchinformation. I furtherauthorize the Companyto obtaincreditand consumerreports.

I understandthat nothingin this employmentapplication, the granting ofaninterviewormy subsequent employmentwiththe Companyisintended tocreate an employmentcontractbetweenmyselfand the Company underwhichmy employmentcould beterminatedonlyforcause.On the contrary I understand and agree that, ifhired,my employmentwillbeterminable atwilland may be terminated byme orthe Company atanytime andfor anyreason. I understand that no person hasany authority toenter into any agreementcontrary totheforegoing.

Ifemployed,Iwillberequiredto provideoriginaldocumentswhich verifymy identityand righttowork in theUnited Statesunder theImmigration Reformand Control Act(IRCA)of1986. The documents) providedwillbe usedforcompletion ofForm 1-9.

I hereby acknowledgethatI have readand agreetothe above statements.

Signature:

Date:

NaNa

References

Please providefourbusinessreferences: (A business reference does not include, friends, family or co-workers. It should be a past manager, supervisor, teacher, pastor, etc.)

Email Addresses are required

  1. Name:_ Title: Relationship toyou: Phone number (includingareacode): Emailaddress:
  1. Name:_ Title: Relationship toyou: Phone number (includingareacode): Emailaddress:
  1. Name:_ Title: Relationship toyou: Phone number (includingareacode): Emailaddress:
  1. Name:_ Title: Relationship toyou: Phone number (includingareacode): Emailaddress:

Applicant Signature: