Employment Opportunities

Please note this application will only remain active for 3 months, after which the applicant would need to re-apply.

Section 1: Personal Information

Date of Application *

Position Applied For *

Date You Can Start *

First Name *

Middle Name *

Last Name *

Social Security Number *

Present Address *

City *

State *

Zip *

Permanent Address *

City *

State *

Zip *

Primary Phone Number *

Secondary Phone Number

Email *

Are you 18 years or older? *YesNo

Are you legally eligible for employment in the United States? *YesNo

Are there any hours or days of the week you cannot work? YesNo

If so, when?

Salary Desired *

Type of Employment Full TimePart TimeCo-Op

Are you employed now? * YesNo

May we contact your present employer? * YesNo

Did you ever apply to this company before? * YesNo

If so, where, when and under what name?

Do you have any physical conditions, which may limit your ability to perform the job for which you are applying? * YesNo

If Yes, describe what accommodations you will need to perform the job.

Section 2: Education

Grade School Name

Grade School Location

Did you graduate grade school? YesNo

High School Name

High School Location

Did you graduate high school? YesNo

Name of College

College Location

Did you graduate college? YesNo

College course of study

College diploma or degree earned

Have you ever been arrested, convicted, pled “guilty” or “no contest” to any crime? * YesNo

If Yes, please state citation, date and place where offense occurred.

Please provide any additional information such as special skills, training, management experience; equipment operation or qualifications you feel will be helpful to us in considering your application.

Section 3: References

List Three Individuals Not Related To You, Whom You Have Known For At Least One Year:

Reference 1 Name*

Reference 1 Address*

Reference 1 Phone Number*

Reference 1 Relationship*

Reference 1 Years Known*

Reference 2 Name*

Reference 2 Address*

Reference 2 Phone Number*

Reference 2 Relationship*

Reference 2 Years Known*

Reference 3 Name*

Reference 3 Address*

Reference 3 Phone Number*

Reference 3 Relationship*

Reference 3 Years Known*

Emergency Contact Name*

Emergency Contact Address*

Emergency Contact Phone Number*

Emergency Contact Relationship*

Section 4: Employment History

Please list your FOUR (4) most recent jobs, beginning with your most recent employer. Account for ALL TIME PERIODS including periods when you were not employed, self-employment and U.S. Military Service.

Position 1 Start Date*

Position 1 End Date*

Position 1 Company Name*

Position 1 Company Phone Number*

Position 1 Company Address*

Position 1 Company City*

Position 1 Company State*

Position 1 Company Zip*

Position 1 Final Title*

Position 1 Final Wage*

Position 1 Reason for Leaving* QuitFiredLay OffCurrently EmployedOther

Position 1 further explanation of separation

Position 2 Start Date*

Position 2 End Date*

Position 2 Company Name*

Position 2 Company Phone Number*

Position 2 Company Address*

Position 2 Company City*

Position 2 Company State*

Position 2 Company Zip*

Position 2 Final Title*

Position 2 Final Wage*

Position 2 Reason for Leaving* QuitFiredLay OffCurrently EmployedOther

Position 2 further explanation of separation

Position 3 Start Date*

Position 3 End Date*

Position 3 Company Name*

Position 3 Company Phone Number*

Position 3 Company Address*

Position 3 Company City*

Position 3 Company State*

Position 3 Company Zip*

Position 3 Final Title*

Position 3 Final Wage*

Position 3 Reason for Leaving* QuitFiredLay OffCurrently EmployedOther

Position 3 further explanation of separation

Position 4 Start Date*

Position 4 End Date*

Position 4 Company Name*

Position 4 Company Phone Number*

Position 4 Company Address*

Position 4 Company City*

Position 4 Company State*

Position 4 Company Zip*

Position 4 Final Title*

Position 4 Final Wage*

Position 4 Reason for Leaving* QuitFiredLay OffCurrently EmployedOther

Position 4 further explanation of separation

May We Contact The Employers Listed? * YesNo

If Not, which one(s)?

PLEASE READ THE FOLLOWING STATEMENT CAREFULLY BEFORE SIGNING TO INDICATE YOUR UNDERSTANDING AND ACCEPTANCE:

CERTIFICATION: 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 may result in termination.
VERIFICATION AUTHORIZATION: I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

PRE EMPLOYMENT/PHYSICAL: I understand that, prior to being offered employment I am requested to take a pre-employment and six panel drug screen examination. In the event that I have a disability that will affect my ability to take the test, I will so inform the Company prior to the administration of the test so that a reasonable accommodation can be made. The Company reserves the right to require medical documentation regarding the need for accommodation. I understand that refusal to take the physical exam and drug screen will disqualify me for employment. I understand that failure of the drug screen will disqualify me for employment.

EMPLOYER/EMPLOYEE: If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the House Parents or President.

EMPLOYMENT ELIGIBILITY VERIFICATION: I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form I this regard.

Digital Signature: By selecting I Accept the facts and statements set forth by me in this application for employment with this company are true and complete. I understand that any false statements or omission of information on this application or any attachment shall be sufficient cause for myself to not be considered for employment. I also understand that, if employed, any false statement or omission on this application or any attachment shall be sufficient cause for dismissal. I acknowledge that I have been advised of my rights under the Fair Credit Reporting Act and I authorize Kindred Spirit to obtain a report from a Consumer Reporting Agency by signing this document. If a report is requested, I have been advised that I can be provided with a copy of the report upon my request. This authorization is in accordance with the Fair Credit Reporting Act.*

I AcceptI Don't Accept