Home Sweet Home Ministries, Bloomington IL - Application for Employment

Position applied for

Date of application // (mm/dd/yyyy)

Name
	LAST		FIRST		MIDDLE

Address
	STREET		CITY		STATE		ZIP CODE

Telephone # ()

Cell/Beeper/Other Phone # ()

Email Address

Are you legally eligible for employment in this country?	Yes No
If you are under 18, can you furnish a work permit if required?	Yes No
Have you ever been employed here before?	Yes No
Date available for work	//
Type of employment desired	Full-time Part-time Temporary
Have you been convicted of a crime within the last seven (7) years—including DUI?	Yes No

If yes, please explain
CONVICTION WILL NOT NECESSARILY BE A BAR TO EMPLOYMENT. EACH INSTANCE AND EXPLANATION WILL BE CONSIDERED IN RELATION TO THE POSITION FOR WHICH YOU ARE APPLYING.
Driver’s license number if driving is an essential job function State

Employment History
Provide the following information for your past four (4) employers, assignments or volunteer activities, starting with the most recent.

From

Employer

Telephone

Your Job Title

Street Address

City

State

Zip

Immediate Supervisor and Title

Nature of work performed and job responsibilities

Reason for Leaving

Hourly Rate/Salary
Start $ per Final $ per

From

Employer

Telephone

Your Job Title

Street Address

City

State

Zip

Immediate Supervisor and Title

Nature of work performed and job responsibilities

Reason for Leaving

Hourly Rate/Salary
Start $ per Final $ per

From

Employer

Telephone

Your Job Title

Street Address

City

State

Zip

Immediate Supervisor and Title

Nature of work performed and job responsibilities

Reason for Leaving

Hourly Rate/Salary
Start $ per Final $ per

From

Employer

Telephone

Your Job Title

Street Address

City

State

Zip

Immediate Supervisor and Title

Nature of work performed and job responsibilities

Reason for Leaving

Hourly Rate/Salary
Start $ per Final $ per

Skills and Qualifications
List any training, skills, licenses, or certification/s that may especially qualify you to perform the functions in the position for which you are applying.

Education

NAME, CITY AND STATE	YEARS COMPLETED	DID YOU GRADUATE? DEGREE / DIPLOMA / GED / CERTIFICATE	COURSE OF STUDY
High School
College
Other

Professional References

NAME	TELEPHONE	YEARS KNOWN
	()
	()
	()
Perons not related to you who are familiar with your experience, traning, skills and character. Examples: employers, supervisors, teachers, or co-workers.

I understand that if I am employed, any misrepresentation or material omission made by me on this application will be sufficient cause to warrant immediate discharge from employment whenever it is discovered.

I give Home Sweet Home Ministries (HSHM) the right to contact and obtain information from all references, employers and educational institutions, and to otherwise verify the accuracy of the information contained in this application. I hereby release HSHM or representatives from any and all liability connected with seeking, gathering and using such information, as well as any and all other persons, corporations or organizations for furnishing such information.

This application is current for 60 days only. If I have not heard from HSHM within that time and still wish to be considered for employment, I understand it will be necessary to fill out a new application.

If I am hired:

I am free to resign at any time, with or without cause and without prior notice.
The employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law.
This application does not constitute an agreement or contract for employment for any specified period or definite duration.
No representative of the employer, other than an authorized officer, has the authority to make any assurances to the contrary. Any such assurances must be in writing and signed by an authorized officer.
I will be required to provide proof of identity and legal authorization to work.
I understand that (1) the Company has a zero-tolerance policy for use, possession, or dispensing of illegal drugs, use of alcohol while at work, or working under the influence of alcohol; (2) the Company?s drug and alcohol policy provides for the pre-employment testing as well as testing after employment; (3) consent to and compliance with such policy is a condition of my employment; and (4) continued employment is based on successfully passing of testing under such policy.

I certify that I have read and fully understand the proceeding and willfully seek employment under these conditions.

Date // (mm/dd/yyyy)

The employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state or federal law.