Esther House Application for Employment

Personal Information

First Name: ______Last Name: ______

Middle name: ______

Street Address: ______City: ______

State /Postal code: ______

Phone #: ______

Date of Birth______

SSN: ______(optional, however if an offer of employment is made, a valid social security number will be required.)

Work Availability: (circle one) Full timepart time overnight

If hired, can you furnish proof that you are eligible to work in the US? ______

If hired, do you expect to be engaged in any additional business or employment outside of our job? If yes explain: ______

Have you ever applied here before? If yes month and year: ______

Were you ever employed here? If yes month and year::______

Position Applying For ______

What date are you available to start work? ______

How did you hear about us? ______

Have you ever been convicted of any law violation? (A conviction will not necessarily disqualify an applicant for employment) If yes explain: ______

______

Are you a veteran? ______

Education

Name and Address of School Degree/Diploma Graduation Date

______

Highest Education Level: ______

Skills and Qualifications: Licenses, Skills, Training, Awards

______

What machines or equipment can you operate? ______

EMPLOYMENT HISTORY:

Present Or Last Position:

Employer: ______

Address: ______

Supervisor: ______

Phone: ______

Email: ______

Position Title: ______

From: ______to: ______

Responsibilities: ______

______

Salary: ______

Reason for Leaving: ______

May We Contact your Employer?

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Previous Positions:

Employer: ______

Address: ______

Supervisor: ______

Phone: ______Email: ______

Position Title: ______

From: ______to: ______

Responsibilities: ______

______

Salary: ______

Reason for Leaving: ______

May We Contact this Employer?

Yes _____ No _____

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Employer: ______

Address: ______

Supervisor: ______

Phone: ______

Email: ______

Position Title: ______

From: ______to: ______

Responsibilities: ______

______

Salary: ______

Reason for Leaving: ______

May We Contact this Employer?

Yes _____ No _____

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Employer: ______

Address: ______

Supervisor: ______

Phone: ______

Email: ______

Position Title: ______

From: ______to: ______

Responsibilities: ______

______

Salary: ______

Reason for Leaving: ______

May We Contact thisEmployer?

Yes _____ No _____

Additional Information

Have you ever been fired from a job or asked to resign? If yes explain

______

What is your current salary? ______

Do you have a valid Driver’s License? ______

Driver’s License #______

Type of License______

State Issued______

Have you had your driver's license suspended or revoked in the past three years? If yes explain.

______

Attach MVR and Other Documents:

A 3 yearMotor Vehicle Record (MVR) from the Department of Motor Vehiclesis requiredfor consideration for employment.

Name 3 References not related to you:

Name/Title Address Phone

______

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.

Signature______

Date______