job app

Applicant Information

Your Contact Information*
Date: *
When can you start?*
Address:
Phone*
-
Cell Phone*
-
Email Address*
May we call you at your current employment?*

General Information

Which position are you applying for?*
Available to work:
Days available to work:
Do you have a legal right to work in the US?
Are you at least 18 years of age?
Have you ever worked for this company?
If so, when?
How did you learn about us?

Education


High School

Name & Address of School
Major
Years Completed
Year Graduated
Degree(s)

College 1

Name & Address of School (College 1)
Major (College 1)
Years Completed (College 1)
Year Graduated (College 1)
Degree(s) (College 1)

College 2

Name & Address of School (College 2)
Major (College 2)
Years Completed (College 2)
Year Graduated (College 2)
Degree(s) (College 2)

Other (Specify)

Name & Address of School (Other)
Major (Other)
Years Completed (Other)
Year Graduated (Other)
Degree(s) (Other)

1) Please summarize any skills, training, licenses, and/or certificates that may qualify you as being able to perform job-related functions in the position you are applying for:
2) Why do you want to be considered for employment here?
3) Please list any job-related professional trade, business, civic activities, organizations, and/or associations. (You may choose to omit those that indicate race, color, national origin, ancestry, sex, age, marital status, or disability.)
4) Are you able to perform all the essential functions of the job you are applying for?
If no, please describe:
5) Are you a veteran of the US military services?
If yes, please state branch of service:
6) Have you ever been convicted of a crime? (A conviction is not an automatic bar to employment. Each case will be considered on its own merits.)
7) Are you currently charged with a crime and awaiting trial?
If yes on #6 or #7, please explain:
8) Does the position you are applying for involve working with or around children?
If yes, have you ever been the subject of allegations related to misconduct with children?
If yes, please explain:

References

Please provide the names of at least 3 people you have known for over 2 years who are not related to you:

Reference 1

Full Name (Reference 1)
Phone or email (Reference 1)
Years Known (Reference 1)

Reference 2

Full Name (Reference 2)
Phone or email (Reference 2)
Years Known (Reference 2)

Reference 3

Full Name (Reference 3)
Phone or email (Reference 3)
Years Known (Reference 3)

Is there anything else you would like to tell us about yourself that would help qualify you for this job?

Company 1:
Company 1 Phone:
-
Company 1 Address:
Company 1 Supervisor:
Company 1 Job Title:
Company 1 Salary (Include Starting and Ending Salary if possible):
Company 1 Job Responsibilities:
Company 1 Start and End dates of employment:
Company 1 reasons for leaving:
May we contact your previous supervisor for a reference?

Do you have another company (2) you'd like to add?:

Company 2:
Company 2 Phone:
-
Company 2 Address:
Company 2 Supervisor:
Company 2 Job Title:
Company 2 Salary (Include Starting and Ending Salary if possible):
Company 2 Job Responsibilities:
Company 2 Start and End dates of employment:
Company 2 reasons for leaving:
May we contact your Company 2 supervisor for a reference?

Do you have another company (3) you'd like to add?:

Company 3:
Company 3 Phone:
-
Company 3 Address:
Company 3 Supervisor:
Company 3 Job Title:
Company 3 Salary (Including Starting and Ending Salary if possible):
Company 3 Job Responsibilities:
Company 3 Start and End dates of employment:
Company 3 reasons for leaving:
May we contact your Company 3 supervisor for a reference?

Do you have another company (4) you'd like to add?:

Company 4:
Company 4 Phone:
-
Company 4 Address:
Company 4 Supervisor:
Company 4 Job Title:
Company 4 Salary (Including Starting and Ending Salary if possible)
Company 4 Job Responsibilities:
Company 4 Start and End dates for employment:
Company 4 reasons for leaving:
May we contact your Company 4 supervisor for a reference?

Certification and Authorization

Information Release

I certify that this information in this application is true and correct to the best of my knowledge, and I agree to allow Northwest Family Services (NWFS) to verify any of this information, unless I indicate in writing to the contrary. I authorize the references and other persons listed on this application, as well as other persons contracted, to verify this and other information I supply in connection with this application, to provide any and all information concerning my previous employment, and/or to supply any other pertinent details they may have. I also release and discharge to the extent permitted by law NWFS, its employees, any individual or agency obtaining information for NWFS, my personal and professional references, and my former employees, from any and all claims, damages, losses, liabilities, costs, and other expenses from disclosing information in connection with this application. I understand that any misrepresentation, falsification, or substantial omission on this application may result in my failure to receive an offer or, if I am hired, my dismissal from employment.

Applicant (Information Release):
Date:

At-Will Statement

I understand that, if I am hired, in the absence of a written employee agreement that states otherwise, I may terminate my employment with NWFS at any time, for any reason. NWFS may do the same. This application does not constitute an agreement or contract for employment for any specified period or definite duration. If I am hired, I agree to conform to the rules and standards of Northwest Family Services.

Applicant (At-Will Statement):
Date:

Background Check Statement

I understand that all offers of employment are contingent upon providing satisfactory proof of identity and legal authority to work in the United States and successful completion of a criminal background check. A background check may include my driving records, court records (civil and criminal), educational and professional credentials, and personal and professional references. This information, which may come from public and private sources, may contain details on my character, experience, work habits, and/or reasons from termination from past employers. I have also disclosed all of this information, including possible criminal activity that will show up on a background check on this form.

Applicant (Background Check Statement):
Date:

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