Fill out the application below and submit for consideration

Last Name*	Middle Name	First Name*


Address*
City*	State*	Zip Code*


Telephone	Cell phone

If you have resided at your present address less than three years, list your prior address
City	State	Zip Code


Referral Source	Position Desired	Salary Expected


Are you available to work?r* "Ctrl-Click" Selects Multiple	If yes, plese give date(s)	List any days and/or times you are not available for work.

Have you ever been employeed here before?	If yes, please give dates	Are you 21 years of age or older?*


Are you a U.S. Citizen or an alien legally entitled to work in the position(s) for which you have applied?
Have you ever been convicted of or pled guilty to a felony or misdemeanor other than a minor traffic violation?
If YES, please explain

What high school did you attend?*	Did you graduate?*

What type of diploma or degree did you receive?	What was your major field of study while in high school?

What College or University did you attend?	How many semesters did you complete?	Did you graduate?


What type of diploma or degree did you receive?	What was your major field of study while in college?


Attend a technical/vocational school?	How many semesters did you complete?	Did you graduate?


What type of diploma or degree did you receive?	What was your major field of study while in a technical/vocational school?

1. Previous Employer (List most recent first)	Dates of employment	What was the position or type of work?
Who was your supervisor?	What were your earnings? (beginning)	What were your earnings? (ending)
What is the telephone number?	What was your reason for leaving?
2. Previous Employer (List most recent first)	Dates of Employment	What was the position or type of work?
Who was your supervisor?	What were your earnings? (beginning)	What were you earnings? (ending)
What is the telephone number?	What was your reason for leaving?
3. Previous Employer (List most recent first)	Dates of Employment	What was the position or type of work?
Who was your supervisor?	What were your earnings? (beginning)	What were your earnings? (ending)
What is the telephone number?	What was your reason for leaving?
4. Previous Employer (List most recent first)	Dates of Employment	What was the position or type of work?
Who was your supervisor?	What were your earnings? (beginning)	What were your earnings? (ending)
What is the telephone number?	What was your reason for leaving?

REFERENCES - Please list three individuals who are not related to you and are not previous employers.
Name:	Address:	Telephone Number:
Name:	Address:	Telephone Number:
Name:	Address:	Telephone Number:

May we contact the employers listed on your employment record?	If no, please indicate which one(s) you do NOT wish us to contact, and please state the reason why you prefer that we do not contact the employer(s).
Have you ever worked under a different name?	If Yes, what was the name you worked under?
Have you ever been discharged or asked to resign from any position?	If Yes, please indicate the employer and dates of employment.

Please indicate with YOUR INITIALS that you have read and understand each paragraph on the Applicant's Statement.


I certify that this application was completed by me and that all entries on it and all information in it are ture and complete to the best of my knowledge. In the event of employment, I understand that false, misleading, or omitted information in my application may result in discharge.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. In making this application for employment, I understand that an investigation may be made and information may be obtained through interviews with the personal references and past employers listed. This inquiry may include information as to my performatnce and workplace conduct. I consent to this investigation and to the consideration of any statements of references or former employers that are given in response to the inquiry.
I hereby release all parties, including but not limited to Bashor Children's Home, personal references, and previous employers, from any and all liability for any injury or damage that may result from their furnishing information to Bashor Children's Home concerning me or any action Bashor Children's Home takes on the bases of such information.
I understand that if I am offered a job as a condition of beginning my employment and any time thereafter as Bashor Children's Home deems necessary, I will be required to undergo a pre-employment physical examination, drug screen, national criminal history check which includes, but is not limited to, fingerprinting and child protective services history. I hereby authorize any doctor, hospital clinic, laboratory or other medical facility to furnish any medical information with reference to me as may be necessary in conjunction with the physical examination and related considerations.
I understand that, according to federal law, all individuals who are hired must, as a condition of employment, produce certain documentation to verify their identity and United States citizen status, or, if aliens, their legal authorization to work in the United States. As a consequence, I understand that any offer of employment to me by Bashor Children's Home is contingent upon my ability to produce the required documentation within the time period required by law.
I understand that this application is not, and is not intended to be, a contract of employment and that any resulting employment relationship is for no fixed period of time and is terminable at any time and for any reason by Bashor Children's Home, or by me. I further understand that statements which may be contained in policies, practices, handbooks, or other Bashor Children's Home material do not create any guarantee of employment and that Bashor Children's Home has the right to modify, amend, or terminate policies, practices, benefit plans, or other programs within the limits and requirements by law. I understand that no representative of Bashor Children's Home, other than an officer, has the authority to enter into any agreement for any specific periods of time or to make any agreement contrary to the foregoing and that such agreement must be in writing to be binding on Bashor Children's Home.

Date*



























Submit
* Required