Job Application - Sisters of Charity of the Blessed Virgin Mary

APPLICANT INFORMATION

Name

First

Last

Date*

Email address*

Present Address

City

State

Zip Code

Permanent Address (If different from above)

City

State

Zip Code

Cell Phone

Home Phone

Best time to reach you

Date available for work

Position applying for*

Other position(s) applying for:

Have you submitted an application here before?

Yes

No

If yes, please provide date(s):

Have you worked here before?

Yes

No

If yes, provide date(s) and position(s) held:

Are you related to anyone who currently works here?

Yes

No

If yes, provide name(s) and relationship(s):

If it has been provided to you, are you able to perform the essential functions as stated in the role description?

Yes

No

Need more information

If no, please explain:

If they have been explained to you, are you able to meet the attendance requirements?

Yes

No

Need more information

If no, please explain:

EDUCATIONAL BACKGROUND

School #1

City, State

Years Completed

Major/Minor or Certification

Completed

Diploma

Degree

Certification

Other

If other, please explain:

School #2

City, State

Years Completed

Major/Minor or Certification

Completed

Diploma

Degree

Certification

Other

If other, please explain:

School #3

City, State

Years Completed

Major/Minor or Certification

Completed

Diploma

Degree

Certification

Other

If other, please explain:

EMPLOYMENT HISTORY

Beginning with your most recent work experience, please provide the following information:

Employer Name

City, State

Last rate of pay:

Date Employed From:

To:

May we contact this employer?

Yes

No

Later

Position:

Supervisor

Phone

Reason for leaving

Employer Name

City, State

Last rate of pay:

Date Employed From:

To:

May we contact this employer?

Yes

No

Later

Position:

Supervisor

Phone

Reason for leaving

Employer Name

City, State

Last rate of pay:

Date Employed From:

To:

May we contact this employer?

Yes

No

Later

Position:

Supervisor

Phone

Reason for leaving

REFERENCES

Name

Phone

Year's Acquainted

Relationship to You

Name

Phone

Year's Acquainted

Relationship to You

Name

Phone

Year's Acquainted

Relationship to You

Applicant’s Certification and Agreement

I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize Sisters of Charity of the Blessed Virgin Mary to verify their accuracy and to obtain reference information on my work performance. I hereby release Sisters of Charity of the Blessed Virgin Mary from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information.

I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal.

I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of the Sisters of Charity of the Blessed Virgin Mary. However, I further understand that neither the policies, rules, regulations of employment or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration and at will and that either I or the Employer may terminate my employment at any time with or without notice or cause.

Applicant's Signature*

Date*