Employment Application (2-Pp.) s8
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SOUTHWEST CRISIS CENTER Employment Application
Applications are considered without regard to race, color, religion, sex, gender identification, national origin, age, marital or veteran status, or the presence of a non-job-related medical condition or handicap.
APPLICANT INFORMATION
Last Name First M.I.
Street Address Apartment/Unit #
City State ZIP
Phone E-mail Address
Date Available Social Security No. Desired Salary
Position Applied for
Are you a citizen of the YES NO If no, are you authorized to YES United States? work in the U.S.? Have you ever worked for YES NO If so, when? this company? Have you ever been YES NO If yes, explain convicted of a felony?
EDUCATION
High School Address
From To Did you graduate?
College Address
From To Did you graduate?
Other Address
From To Did you graduate?
REFERENCES Please list three PROFESSIONAL references.
Full Name Job Title
Company Phone
Address
Full Name Job Title
Company Phone Address
Full Name Job Title
Company Phone
Address
PREVIOUS EMPLOYMENT
Company Phone
Address Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? YES NO
Company Phone
Address Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? YES NO
Company Phone
Address Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? YES NO
MILITARY SERVICE
Branch From To
Rank at Discharge Type of Discharge
If other than honorable, explain
DISCLAIMER AND SIGNATURE I certify that my answers are true and complete to the best of my knowledge. I authorize Southwest Crisis Center and/or its representatives to investigate any statement contained in this application as necessary to determine my qualifications. I understand that this application is not and is not intended to be any kind of contract or agreement. In the event of employment, I understand that any false or misleading information given in my application, correspondence, discussions, or interview may result in immediate termination.
Signature Date