Fillable EMPLOYMENT APPLICATION

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EMPLOYMENT APPLICATION

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The EMPLOYMENT APPLICATION form is 4 pages long and contains:

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  • 26 check-boxes
  • 100 other fields

Country of origin: OTHERS
File type: PDF

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EMPLOYMENT APPLICATION
1 | Page
APPLICANT INFORMATION
Last Name First M.I. Date
Street Address Apartment/Unit #
City State ZIP
Phone E-mail Address
Position Applied for
Are you a citizen of the United States? YES NO If no, are you authorized to work in the U.S.? YES NO
Are you 18 or older?
YES NO
Salary Requirements $
EDUCATION
High School Address
Did you graduate? YES NO Degree
College Address
From To Did you graduate? YES NO Degree
Other Address
From To Did you graduate? YES NO Degree
LIST PROFESSIONAL REFERENCES ONLY
Please list three professional references.
Full Name Relationship
Company Phone ( )
Address
Email
Address
# of years
acquainted
Full Name Relationship
Company Phone ( )
Address
Email
Address
# of years
acquainted
Full Name Relationship
Company Phone ( )
Address
Email
Address
# of years
acquainted
EMPLOYMENT APPLICATION
2 | Page
PREVIOUS EMPLOYMENT
Company Phone ( )
Address Supervisor
Job Title
Responsibilities
Reason for Leaving From To
May we contact your previous employer? YES NO
Company Phone ( )
Address Supervisor
Job Title
Responsibilities
Reason for Leaving From To
May we contact your previous employer? YES NO
Company Phone ( )
Address Supervisor
Job Title
Responsibilities
Reason for Leaving From To
May we contact your previous employer?
YES NO
MILITARY SERVICE
Branch From To
Rank at Discharge Type of Discharge
If other than honorable, explain
EMPLOYMENT APPLICATION
3 | Page
DISCLAIMER AND SIGNATURE
The information contained in this application is correct to the best of my knowledge. I hereby authorize Habitat for
Humanity-Spokane and its designated agents and representatives to conduct a comprehensive review of my background
causing a consumer report and/or an investigative consumer report to be generated for employment and/or volunteer
purposes. I understand that the scope of the consumer report/ investigative may include, but is not limited to the following
areas: verification of social security number; current and previous residences; employment history, education background,
character references; drug testing, civil and criminal history records from any criminal justice agency in any or all federal,
state, county jurisdictions; driving records, birth records, and any other public records.
I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration
and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to Habitat for
Humanity-Spokane or its agents. I further authorize the complete release of any records or data pertaining to me which the
individual, company, firm, corporation, or public agency may have, to include information or data received from other
sources.
I hereby release Habitat for Humanity-Spokane, the Social Security Administration, and its agents, officials,
representative, or assigned agencies, including officers, employees, or related personnel both individually and
collectively, from any and all liability for damages of whatever kind, which may, at any time, result to me, my heirs, family,
or associates because of compliance with this authorization and request to release.
Signature Date
Habitat for Humanity-Spokane provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination
and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual
orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer,
leaves of absence, compensation and training.
EMPLOYMENT APPLICATION
4 | Page
Affirmative Action Voluntary Information
Completion of information below is voluntary
To be completed by applicant on a voluntary basis. Not for interview purposes. To be filed separately from application.
In an effort to comply with requirements regarding government record keeping, reporting and other legal obligations that may apply,
we invite you to complete this applicant data survey. Providing this information is STRICTLY VOLUNTARY. Failure to provide it will
not subject you to any adverse personnel decision or action. Your cooperation is appreciated.
Please be advised that this survey is not a part of your official application for employment. It will not be used in any hiring
decision. The information will be used and kept confidential in accordance with applicable laws and regulation.
Please Print
Position(s) applied for
Referral Source:
Walk-in Government Employment Agency Private Employment Agency
Employee Relative School
Advertisement-Source
Male Female
White
Black or African American and White
American Indian/Alaskan Native
Asian/Pacific Islander Multiracial (parents of different races)
Please check one of the following Equal Empl
oyment Opportunity Identification Groups:
Are you Hispanic or Latino?
Yes
I do not wish to provide this information
We consider all applicants for positions without regard to race, color, religion sex, national origin, citizenship, age
mental or physical disabilities, veteran/reserve/national guard or any other similarly protected status. We also comply
with all applicable laws governing employment practices and do not discriminate on the basis of any unlawful criteria.
Gender:
No
Black or African American
Please check one of the following Equal Employment Opportunity Identification Groups:
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EMPLOYMENT APPLICATION

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Completed 20 August 2021

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