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EMPLOYMENT APPLICATION
Partnerships for People, Inc. does not discriminate in hiring on the basis of race, color, religious creed, national origin, sex, sexual orientation, ancestry or on the basis of age or against any person because he or she is mentally or physically handicapped, a disabled veteran, or a veteran of the Vietnam Era. No question on this application is intended to secure information to be used for such discrimination.
In processing this application, Partnerships for People, Inc. may conduct an investigation seeking information as to your prior employment history, character and general reputation, driver’s record, police record, and credit reports. You have the right to request that Partnerships for People, Inc. completely and accurately disclose to you the nature and scope of the investigation conducted. Such requests must be made in writing to Personnel within three weeks after you complete this application.
Name:
Street Address:
City: Zip:
Best number to reach you:
Alternate number:
E-mail address:
Type of employment desired: Full-time Part-time Substitute
Position applied for:
Are you able to meet the attendance requirements of the position?
Are you related to anyone who works or has worked for us? Who?
How were you referred to us? (If newspaper ad, give name of paper)
Have you applied here before? Worked here before? When?
Are you legally permitted to work in the United States?
Are you 18 years of age or older?
Have you ever been convicted of a crime?
(Such conviction may be relevant if job related, but does not bar you from employment.)
If yes, please explain:
What are your salary requirements? Date available
Do you have a valid driver’s license?
Employment History - please list your three most recent employers:
1.Company name:
Complete mailing address:
Nature of business: Phone:
Supervisor/title:
Salary:
Job title:
Employed from: to:
Job duties:
May we contact for a reference?
Reason(s) for leaving:
2. Company name:
Complete mailing address:
Nature of business: Phone:
Supervisor/title:
Salary:
Job title:
Employed from: to:
Job duties:
May we contact for a reference?
Reason(s) for leaving:
3. Company name:
Complete mailing address:
Nature of business: Phone:
Supervisor/title:
Salary:
Job title:
Employed from: to:
Job duties:
May we contact for a reference?
Reason(s) for leaving:
ADDITIONAL EXPERIENCE:
Please indicate any work experience you have acquired through military service or volunteer organizations (except those which would reveal race, creed, color, age, sex, religion, national origin, or other protected status).
Name of Organization Dates Position/Duties
Why do you want to be employed by Partnerships for People, Inc.?
If you are fluent in any foreign language(s), please list the language(s) in the boxes below and check the box that best describes your skill level.
Language Read & Write Read & Speak Read Only Speak Only
Language Read & Write Read & Speak Read Only Speak Only
Language Read & Write Read & Speak Read Only Speak Only
List professional, trade, business or civic associations and any offices held. (Exclude memberships which would
reveal sex, race, religion, national origin, age, color, disability or other protected status.)
List special accomplishments, publications, awards. (Exclude information which would reveal sex, race,
religion, national origin, age, color, disability or other protected status.)
List any additional information you would like Partnerships for People to consider when reviewing your application.
Do you have experience working with people with developmental disabilities?
If yes, please describe:
Education:
Do you have a high school diploma or its equivalent?
Name of High School:
Highest degree completed:
College or University:
Trade School or Professional School:
REFERENCES
List below three business references who are not related to you and can comment on your work performance,
ability, and character.
1. Name:
Phone number:
Name of company:
Company address:
His or her title or position:
Years acquainted:
2. Name:
Phone number:
Name of company:
Company address:
His or her title or position:
Years acquainted:
3. Name:
Phone number:
Name of company:
Company address:
His or her title or position:
Years acquainted:
I understand that any misrepresentation or omission of facts is cause for my immediate disqualification for consideration of employment or termination if employed. Further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any previous notice. I authorize investigation of all statements contained in this application.
I have read and agree to these conditions and certify that the information contained herein is accurate to the best of my knowledge.
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