Application for Employment

We appreciate your interest in Vera House. Vera House offers equal opportunities to all persons without regard to race, color, religion, age, gender, disability (including pregnancy, childbirth and related medical conditions), national origin, ancestry, citizenship, military or veteran status, marital status, familial status, sexual orientation, gender identity or expression, domestic violence victim status, predisposing genetic characteristics or genetic information, or any other status protected by law. We will endeavor to make a reasonable accommodation/modification to the known physical or mental limitations of a qualified applicant with a disability to assist in the hiring process, unless the accommodation would impose an undue hardship on the operation of our business, in accordance with applicable federal, state and local law. Applicants who require reasonable accommodation during the application process may contact Human Resources.

Date of Application:

mm/dd/yyyy

Personal Information

First Name:

Middle Name:

Last Name:

Address:

City:

State:

Zip/Postal Code:

Country:

Phone:

999-999-9999

Email Address:

Are you at least 18 years of age?

Yes No

Are you legally eligible for employment in this country?

Yes No

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required I-9 employment eligibility verification document form upon hire.

Employment Desired

Position(s) applied for:

Date you can start:

mm/dd/yyyy

Have you ever worked for Vera House before?

Yes No

If yes, please give dates and supervisor:

Reason for Leaving:

Education

Highest Grade Completed: Grade School: 2 Grade School: 3 Grade School: 4 Grade School: 5 Grade School: 6 Grade School: 7 Grade School: 8 High School: 9 High School: 10 High School: 11 High School: 12 College: 1 College: 2 College: 3 College: 4 College: 5+

Name of Last School Attended:

Degree Obtained:

License, Vocational, or Trade Training:

Professional References

Please give the names of persons not related to you, whom you have known professionally at least three years.

Professional Reference 1

Name:

Telephone:

999-999-9999

Email:

Position:

Years Known:

Professional Reference 2

Name:

Telephone:

999-999-9999

Email:

Position:

Years Known:

Professional Reference 3

Name:

Telephone:

999-999-9999

Email:

Position:

Years Known:

Employment History

Employer 1

Begin with your current or most recent employer.

Dates Employed:

From to

Employer:

Street Address:

City:

State:

Zip:

Job Title:

Supervisor Name:

(for most recent position)

Supervisor Telephone:

999-999-9999

Supervisor Email:

Briefly describe your job duties and work experience:

Reason for Leaving:

Employer 2

Dates Employed:

From to

Employer:

Street Address:

City:

State:

Zip:

Job Title:

Supervisor Name:

(for most recent position)

Supervisor Telephone:

999-999-9999

Supervisor Email:

Briefly describe your job duties and work experience:

Reason for Leaving:

Add another employer

Employer 3

Dates Employed:

From to

Employer:

Street Address:

City:

State:

Zip:

Job Title:

Supervisor Name:

(for most recent position)

Supervisor Telephone:

999-999-9999

Supervisor Email:

Briefly describe your job duties and work experience:

Reason for Leaving:

Add another employer

Employer 4

Dates Employed:

From to

Employer:

Street Address:

City:

State:

Zip:

Job Title:

Supervisor Name:

(for most recent position)

Supervisor Telephone:

999-999-9999

Supervisor Email:

Briefly describe your job duties and work experience:

Reason for Leaving:

May we contact your present employer at this time?

Yes No

Cover Letter and Resume

Cover Letter:

Upload a Word, WPS or PDF copy of your cover letter.

Resume:

Upload a Word, WPS or PDF copy of your resume.

Applicant Statement

I understand and agree that nothing in this application shall constitute an offer, a contract or a guarantee of employment for a specific period of time. If hired, I understand that my employment with Vera House is on an at-will basis, which means that my employment may be terminated with or without cause and with or without notice at any time, at the will of Vera House or me. I further understand that no representative or agent of Vera House, other than the Executive Director, has the authority to enter into any agreement for employment for any specific period of time or to make an agreement contrary to the foregoing. I also understand that any agreement modifying my at-will employment status must be in writing and signed by the Executive Director. I give Vera House permission to contact all or any of my previous employers and references and authorize them to disclose any information Vera House may request in the course of its investigation of this application for employment and I hereby release Vera House and such references and prior employers from any and all liability with respect to such disclosures.

After a tentative offer of employment has been made, I understand that any offer of employment is conditioned upon receipt of satisfactory references. I also understand that I may be requested now or at any subsequent time during my employment with Vera House to submit to drug and/or alcohol tests, at the expense of Vera House. I understand that if I refuse to take the test, my employment may be terminated immediately. I also understand that if a conditional offer of employment is made, the Agency performs criminal background checks. A criminal conviction will not necessarily exclude me from consideration. Rather, each situation will be addressed on an individual basis, consistent with applicable law.

I have provided truthful and complete responses to all inquiries in the application and authorize Vera House to investigate all statements contained in the application. I understand that the discovery of any falsification or omission constitutes a ground for immediate dismissal or refusal to hire. If employed, I will abide by Vera House’s rules and regulations, which I understand are subject to change by Vera House.

DO NOT CHECK THE BOX UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

Applicant Name: Date:

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