Job Application Form

Candidate's Name*

Date*

Address*

Street Address City State ZIP Code

Are you 18 years of age or older?*

Yes
No

Are you either a U.S. citizen or an alien authorized to work in the U.S.?*

Yes
No

Have you ever worked or attended school under another name? If so, under what name?

Position Desired

Position*

Start date available*

Wage rate desired*

Hourly/monthly/annually*

Hourly
Monthly
Annually

Do you prefer:*

Full-time
Part-time

If part-time, hours per week desired:

Hours you are available to work:*

Days of week you are available to work:*

Are you able to work:

Weekends
Holidays
Nights
Overtime

Have you previously worked for Strength In Peers?*

Yes
No

Dates of employment with Strength In Peers:

Reason(s) for leaving:

Former supervisor(s) at this company:

How did you hear about this opening?

Education

High School

Graduated?

Yes
No

Course of Study:

Technical School

Graduated?

Yes
No

Course of Study:

College/University

Graduated?

Yes
No

Course of Study:

Post-Graduate Education

Graduated?

Yes
No

Course of Study:

Other education, training, or special skills:

Skills

Typing speed (WPM)

Are you experienced in using personal computers?

Yes
No

Are you able to use Microsoft Word or Excel? What other programs are you capable of using?

Work Experience

Employer

Address

Street Address City State ZIP Code

Dates of employment

Position Held

Reason for leaving

Supervisor's Name & Title

May we contact?

Yes
No

Description of Duties:

Starting Compensation:

Final Compensation:

Employer

Address

Street Address City State ZIP Code

Dates of employment

Position Held

Reason for leaving

Supervisor's Name & Title

May we contact?

Yes
No

Description of Duties:

Starting Compensation:

Final Compensation:

Employer

Address

Street Address City State ZIP Code

Dates of employment

Position Held

Reason for leaving

Supervisor's Name & Title

May we contact?

Yes
No

Description of Duties:

Starting Compensation:

Final Compensation:

References

Name

Phone

Email

Address

Street Address City State ZIP Code

Position or Title:

Years Known:

Name

Phone

Email

Address

Street Address City State ZIP Code

Position or Title:

Years Known:

Name

Phone

Email

Address

Street Address City State ZIP Code

Position or Title:

Years Known:

Authorization and Acknowledgements

I affirm that the information I have provided in this application is true to the best of my knowledge, information and belief, and I have not knowingly withheld any information requested. I understand that withholding or misstating any information requested in this application is grounds for rejection of my application, and that providing false or misleading information in this application is grounds for discharge.

I authorize the company to verify my references, record of employment, education record, and any other information I have provided. Unless otherwise noted, I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the organization, my former employers and all other persons and entities, from any and all claims, demands or liabilities arising out of or in any way related to such inquiry or disclosure.

Candidate's Signature*

Date*

Phone

This field is for validation purposes and should be left unchanged.

Strength In Peers

Application for Employment

Position Desired

Education

High School

Technical School

College/University

Post-Graduate Education

Skills

Work Experience

References

Authorization and Acknowledgements

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Strength In Peers

Application for Employment

Position Desired

Education

High School

Technical School

College/University

Post-Graduate Education

Skills

Work Experience

References

Authorization and Acknowledgements

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Follow Our Journey

Subscribe To Our Enewsletter

540.217.0869

Email Us

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