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INSTRUCTIONS FOR COMPLETING

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1
THACCD 101A (revised 12/20)
THE HOUSING AUTHORITY OF THE CITY AND COUNTY OF DENVER
EMPLOYMENT APPLICATION
Housing Authority of the
City and County of Denver
P.O. Box 40305
Denver, Colorado 80204-0305
http://www.denverhousing.org
Received:
For Official Use Only:
QUAL:
DNQ:
Experience
Training
Other:
INSTRUCTIONS FOR COMPLETING
DHA is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any
other status protected by law or regulation. It is our intention that all qualified applicants are given equal opportunity and that selection
decisions be based on job-related factors.
Please print or type using dark ink. Each question should be fully and accurately answered. No action can be taken on this application until all
questions have been answered. Use blank paper if you do not have enough room on this application. Please write in print, except for the
signature on the last page of this application. A resume may also be submitted, but the application form must be completed in the detail
requested.
Please return the completed application to: The Housing Authority of the City and County of Denver, Human Resources, 1035 Osage Street
9th Floor, Denver, Colorado 80204 or fax to 720-932-3005 or email to hr@denverhousing.org
--Information on this application will be verified--
PERSONAL INFORMATION
Position applying for: Date available for work
Salary Requirement:
NAME:(Last, First, Middle)
ADDRESS:(Street, Unit Number, City, State, Zip Code)
HOME PHONE:
ALTERNATE PHONE:
MOBILE PHONE NUMBER:
EMAIL ADDRESS:
DRIVER'S LICENSE:
Yes No
DRIVER'S LICENSE NUMBER:
State: Number:
LEGAL RIGHT TO WORK IN THE UNITED STATES?
Yes No
EDUCATION
NAME OF HIGH SCHOOL:
ADDRESS:
GED CERTIFICATE Yes No
GED CERTIFICATE NUMBER:
LOCATION:
COLLEGES/TECHNICAL SCHOOLS ATTENDED:
SCHOOL NAME:
LOCATION:(City, State)
DID YOU GRADUATE?
Yes No
DEGREE RECEIVED:
MAJOR:
UNITS COMPLETED:
SCHOOL NAME:
LOCATION:(City, State)
DID YOU GRADUATE?
Yes No
DEGREE RECEIVED:
MAJOR:
UNITS COMPLETED:
SCHOOL NAME:
LOCATION:(City, State)
DID YOU GRADUATE?
Yes No
DEGREE RECEIVED:
MAJOR:
UNITS COMPLETED:
2
THACCD 101A (revised 12/20)
WORK EXPERIENCE
(If unemployed for periods of longer than a month, please include those dates in this section. At least seven (7) years of history is required)
EMPLOYER:
DATES:
From: To:
POSITION TITLE:
ADDRESS:(Street, City, State, Zip Code)
COMPANY WEBSITE:
PHONE NUMBER:
SUPERVISOR:
HOURS PER WEEK:
MAY WE CONTACT THIS EMPLOYER?
Yes No
DUTIES:
REASON FOR LEAVING:
EMPLOYER:
DATES:
From: To:
POSITION TITLE:
ADDRESS:(Street, City, State, Zip Code)
COMPANY WEBSITE:
PHONE NUMBER:
SUPERVISOR:
HOURS PER WEEK:
MAY WE CONTACT THIS EMPLOYER?
Yes No
DUTIES:
REASON FOR LEAVING:
EMPLOYER:
DATES:
From: To:
POSITION TITLE:
ADDRESS:(Street, City, State, Zip Code)
COMPANY WEBSITE:
PHONE NUMBER:
SUPERVISOR:
HOURS PER WEEK:
MAY WE CONTACT THIS EMPLOYER?
Yes No
DUTIES:
REASON FOR LEAVING:
EMPLOYER:
DATES:
From: To:
POSITION TITLE:
ADDRESS:(Street, City, State, Zip Code)
COMPANYWEBSITE:
PHONE NUMBER:
SUPERVISOR:
HOURS PER WEEK:
MAY WE CONTACT THIS EMPLOYER?
Yes No
DUTIES:
REASON FOR LEAVING:
3
THACCD 101A (revised 12/20)
EMPLOYER:
DATES:
From: To:
POSITION TITLE:
ADDRESS:(Street, City, State, Zip Code)
COMPANYWEBSITE:
PHONE NUMBER:
SUPERVISOR:
HOURS PER WEEK:
MAY WE CONTACT THIS EMPLOYER?
Yes No
DUTIES:
REASON FOR LEAVING:
EMPLOYER:
DATES:
From: To:
POSITION TITLE:
ADDRESS:(Street, City, State, Zip Code)
COMPANYWEBSITE:
PHONE NUMBER:
SUPERVISOR:
HOURS PER WEEK:
MAY WE CONTACT THIS EMPLOYER?
Yes No
DUTIES:
REASON FOR LEAVING:
EMPLOYER:
DATES:
From: To:
POSITION TITLE:
ADDRESS:(Street, City, State, Zip Code)
COMPANYWEBSITE:
PHONE NUMBER:
SUPERVISOR:
HOURS PER WEEK:
MAY WE CONTACT THIS EMPLOYER?
Yes No
DUTIES:
REASON FOR LEAVING:
EMPLOYER:
DATES:
From: To:
POSITION TITLE:
ADDRESS:(Street, City, State, Zip Code)
COMPANYWEBSITE:
PHONE NUMBER:
SUPERVISOR:
HOURS PER WEEK:
MAY WE CONTACT THIS EMPLOYER?
Yes No
DUTIES:
REASON FOR LEAVING
4
THACCD 101A (revised 12/20)
CERTIFICATES AND LICENSES
TYPE:
LICENSE NUMBER:
ISSUING AGENCY:
TYPE:
LICENSE NUMBER:
ISSUING AGENCY:
TYPE:
LICENSE NUMBER:
ISSUING AGENCY:
SKILLS
OFFICE SKILLS: If you are an experienced operator of any business machine or equipment, including computer hardware/software, please list below. Include skill
level and year last used:
DO YOU KEYBOARD? Yes No Words per minute:
OTHER SKILLS NOT LISTED ABOVE:
LANGUAGE(S): State whether reading, speaking or writing:
Additional Information
REFERENCES (Professional or Personal – Do Not List Relatives)
REFERENCE TYPE:
NAME:
POSITION/RELATIONSHIP TO CANDIDATE:
ADDRESS:(Street, City, State, Zip Code)
EMAIL ADDRESS:
PHONE NUMBER:
REFERENCE TYPE:
NAME:
POSITION/RELATIONSHIP TO CANDIDATE:
ADDRESS:(Street, City, State, Zip Code)
EMAIL ADDRESS:
PHONE NUMBER:
REFERENCE TYPE:
NAME:
POSITION/RELATIONSHIP TO CANDIDATE:
ADDRESS:(Street, City, State, Zip Code)
EMAIL ADDRESS:
PHONE NUMBER:
5
THACCD 101A (revised 12/20)
Supplemental Questions
1.
Are you now or have you ever been employed by the Housing Authority of the City and County of Denver (DHA)? Yes No
Please explain. (Past DHA employment)
2.
IMMIGRATION REFORM ACT: The Immigration Reform Act of 1986 requires both identity and eligibility for employment proof within three days of
employment. DHA does NOT hire or sponsor H-1 Visa holders. Upon offer of employment, are you able to provide proof that you are eligible to work in the
United States without sponsorship (NAFTA, Green Card, US Citizen, or Permanent Resident)? Yes No
3.
Have you been fired or asked to resign from any job during the past five years? Yes No
Please explain. (Fired or asked to resign)
4.
Have you ever been found guilty of ANY law violations other than parking tickets or juvenile offenses? Records do not cause automatic disqualification, but
are reviewed as related to job(s) applied for. Be honest. If you have any convictions, list them here. If you do not remember your record, contact the
appropriate law enforcement agency for this information. DHA is as interested in honest and accurate disclosure as in the record itself.
Please explain. (Law violations)
5.
Have you ever served on active duty (excluding training as a reservist or guardsman) in the U.S. Military Service? Yes No
6.
Are you currently a DHA resident or receiving Section 8 Housing assistance? Yes No
Please Specify:
7.
Are you a Section 3 eligible applicant? Yes No
Please Specify:
8.
Are you related to any employee of DHA? Yes No
Please give name and relationship:
9.
Please list other names you have used:
Additional Information
VOLUNTEER EXPERIENCE: Volunteer activities and non-paid experiences related to position for which you are applying should be submitted on an additional
sheet.
EDUCATION: If you are selected for hire, a copy of your high school diploma or GED high school equivalent certificate will be required. Official transcripts of
education may be required for certain positions.
DRIVING RECORD: If the job you are applying for requires driving, a copy of your driving record will be required prior to hire. If your driving record is not
acceptable pursuant to DHA’s Personnel Policy, you may be disqualified for hire.
NOTIFICATION: Your application will be kept on file for six months. If you are selected for testing and interview, you will be notified as soon as possible.
KEEP US UP TO DATE: If your availability, address or phone number changes after you file this application, notify us immediately. Failure to do so may result in
non-delivery of mail or cause your name to be removed from the applicant list.
BACKGROUND INVESTIGATION: New employees are investigated carefully, including national and local criminal background checks. Be sure to list any crimes for
which you were found guilty within the last seven (7) years. Include any plea of guilty or nolo contendere. False statements or omissions may result in
disqualification or dismissal.
In connection with your application for employment, please be advised that we may conduct a reference check. As an applicant for employment with DHA, you
are a consumer with rights under the Fair Credit Reporting Act. For explanation purposes, a “consumer reporting agency” is a person or business which, for
monetary fees, dues, or on a cooperative nonprofit basis, regularly assembles or evaluates consumer credit information or other information on consumers for
the purpose of furnishing consumer reports to others, such as DHA.
An “investigative consumer report” means a consumer report or portion thereof in which information on your character, general reputation, personal
characteristics, or mode of living is obtained through personal interviews with your neighbors, friends, or associates or with others with whom you are acquainted
or who may have knowledge concerning any such items of information.
In the event an investigative consumer report is prepared, you may request additional disclosures regarding the nature and scope of the investigation requested
as well as a written summary of your rights under the Fair Credit Reporting Act.
YES NO
6
THACCD 101A (revised 12/20)
Affidavit, Consent and Release:
I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me
from further consideration for employment and may result in my immediate dismissal if discovered at a later date.
I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer,
past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I agree to execute DHA’s
Authorization and Agreement of Release and Waiver releasing such parties from any liability in providing such information and opinions.
I understand that I may be required to successfully pass a drug screening examination. I hereby consent to a pre-and/or post-employment drug screen as a
condition of employment, if required.
I understand that if I am extended an offer of employment, it may be conditioned upon my successfully passing a complete pre-employment physical
examination. I consent to the release of any and all medical information as may be deemed necessary to judge my capability to do the work for which I am
applying.
I understand that this application, verbal statements by management, or subsequent employment does not create an express or implied contract of employment
nor guarantee employment for any definite period of time. Final decisions regarding hiring will be made by the Executive Director of the Housing Authority of the
City and County of Denver and my employment may be terminated at any time with or without reason and with or without notice.
Signature Date
This application for employment will remain on file for a limited time of six months.
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INSTRUCTIONS FOR COMPLETING

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Completed 22 November 2021

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