Employment Application

PERSONAL DATA

Date

Position Applying For

Wage Desired: $

How did you hear about this position?

When would you be available for work?

First Name*

Middle Name

Last Name*

Present Address

City

State

Zip

Home Phone*

Cell Phone

Email*

Are you an United States Citizen Yes No

If not, what type of Visa do you have?

Exp. Date:

Do you have a driver's license? Yes No

Driver’s License Number

State of Issue

Expiration Date

EDUCATION

HIGH SCHOOL

Name of School

Address

City

State

ZIp

Number of years Completed

Dates Attended

COLLEGE

Name of School

Mailing Address

City

State

ZIp

Number of years Completed

Dates Attended

Major & Degree

BUSINESS OR TRADE SCHOOL

Name of School

Mailing Address

City

State

ZIp

Number of years Completed

Dates Attended

Major & Degree

PROFESSIONAL SCHOOL

Name of School

Mailing Address

City

State

Zip

Number of years Completed

Dates Attended

Major & Degree

BACKGROUND

Have you ever been convicted of a crime? Yes No

If Yes, explain conviction(s), nature of offense(s), State(s) where offenses occurred, and Sentence(s) imposed by the Court

** You will not be denied employment solely because of a convictions records, unless the offense is related the job for which you applied.

TELL US ABOUT YOURSELF AND YOUR QUALIFICATIONS

Use the space below to summarize additional information describing your experience and full qualifications for the position for which you applying. You may also include any explanations you feel would be helpful in understanding other issues in your application.

REFERENCES

Please list three personal/professional references

REFERENCE #1

Name

Address

City

State

Zip

Telephone

REFERENCE #2

Name

Address

City

State

Zip

Telephone

REFERENCE #3

Name

Address

City

State

ZIp

Telephone

WORK EXPERIENCE

POSITION #1

Employer/Company

Supervisor

Address

City

State

Zip

Position

Phone

Salary:$

EMPLOYMENT DATES

From

To

Reason for leaving

May we contact Yes No

List the duties you performed, skills you used of learned, positions held and promotion

POSITION #2

Employer/Company

Supervisor

Address

City

State

Zip

Position

Phone

Salary:$

EMPLOYMENT DATES

From

To

Reason for leaving

May we contact Yes No

List the duties you performed, skills you used of learned, positions held and promotion

POSITION #3

Employer/Company

Supervisor

Address

City

State

Zip

Position

Phone

Salary:$

EMPLOYMENT DATES

From

To

Reason for leaving

May we contact Yes No

List the duties you performed, skills you used of learned, positions held and promotion

POSITION #4

Employer/Company

Supervisor

Address

City

State

Zip

Position

Phone

Salary:$

EMPLOYMENT DATES

From

To

Reason for leaving

May we contact Yes No

List the duties you performed, skills you used of learned, positions held and promotion

APPLICATION FORM WAIVER

PLEASE READ CAREFULLY

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed; falsified statements on this application shall be grounds for dismissal at any time without any previous notice. I herby give Calvary Counseling Center permission to contact schools, previous employer (unless otherwise indicated), references, and others. I further authorize the company to obtain a copy of my driving record. I hereby release Calvary Counseling Center from any liability as a result of such contacts, inquiries, or records in order to ascertain my qualifications and fitness for employment.

I further understand that my employment with Calvary Counseling Center shall be probationary for a period 12 months, and further that at any time during the probationary period or thereafter, my employment relationship with Calvary Counseling Center is terminable “at will” for any reason by either party.

Calvary Counseling Center is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, national origin, age or disability. We assure you that your opportunity for employment with Calvary Counseling Center depends solely on your qualifications.

Appropriate accommodations for individuals with disabilities will be provided upon request. We require eight business days notice prior to the event.

Thank You for completing the application form and for your interest in our organization.

Digital Signature of applicant

Date

Verification

Thank you for filling out the Employment Application.

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