P.O. Box 11525  Roanoke, VA 24022  (540) 343-7227

Application for Employment

Please answer all questions, even if you submit a resume’

(Please Print)

Date / Position(s) applied for
How did you learn about the Rescue Mission?
Advertisement Friend Walk-in
Employment Agency Relative Other
Name
Last Name, First Name, Middle Name
Address
Street, City, State, Zip
E-mail
Phone No(s) Home: Cell: Other:
Social Security Number --

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 with us before? Yes No

If yes, give date:

Have you ever been employed with us before? Yes No

If yes, give date(s):

Are you currently employed? Yes No

May we contact your present employer? Yes No

Are you prevented from lawfully becoming employed in this country due to Visa of Immigration Yes No

Status? (Proof of citizenship or immigration status will be required upon employment.)

On what date would you be available for work?

Are you available to work Full Time Part Time Shift Work Temporary

Are you currently on "lay-off" status and subject to recall? Yes No

Have you been convicted of a felony within the last 7 years? Yes No

(Conviction will not necessarily disqualify an applicant from employment.)

If yes, please explain:

Have you been convicted of a sex related or child abuse crime? Yes No

Do you understand that the Rescue Mission does not hire employees who use alcohol, Yes No

illegal drugs, or tobacco?

Do you have a valid, unrestricted Virginia driver’s license? Yes No

The Rescue Mission is a tobacco free campus. Do you smoke? Yes No

Education

Name & Address / Course of Study / Attended
From-To (Years) / Diploma/Degree
Earned
Elementary School
High School
Undergraduate College
Graduate/
Professional
Other (specify)

References

Please do not include any family members, relatives or Rescue Mission Employees. Provide completee-mail addresses as this is how we prefer to contact your references.

  1. Name

Address

Phone No.E-mail

  1. Name

Address

Phone No.E-mail

  1. Name

Address

Phone No.E-mail

  1. PLEASE LIST YOUR PASTOR AS YOUR 4TH REFERENCE

Name

Address

Phone No.E-mail

Employment Experience

Start with present or last job. Include any job-related military service assignments and volunteer activities.

Employer: / Dates Employed / Work Performed
From: To:
Address:
Telephone Number: / Hourly Rate/Salary
Start: End:
Job Title: / Supervisor:
Reason for leaving:
Employer: / Dates Employed / Work Performed
From: To:
Address:
Telephone Number: / Hourly Rate/Salary
Start: End:
Job Title: / Supervisor:
Reason for leaving:
Employer: / Dates Employed / Work Performed
From: To:
Address:
Telephone Number: / Hourly Rate/Salary
Start: End:
Job Title: / Supervisor:
Reason for leaving:
Employer: / Dates Employed / Work Performed
From: To:
Address:
Telephone Number: / Hourly Rate/Salary
Start: End:
Job Title: / Supervisor:
Reason for leaving:

Additional Information

Other Qualifications – Summarize special job-related skills and qualifications acquired from employment or other experience.

The Rescue Mission is a Christian crisis intervention center. All of its employees are “ministers” in the Christian faith. What do you feel your “ministry” at the Rescue Mission will be?

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Author: monica.schlagetter