Human Resources -- Shalom House, Inc.

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

Shalom House Online Employment Application:

GENERAL INFORMATION

Today's Date:
First, Middle and Last Name:
Street Address:
City:
State:
Zip Code:
Telephone Number:
Social Security Number:
E-Mail Address:

OTHER INFORMATION

The position you are applying for is:

Are you legally eligible to work in the United States?
NOTE: Proof of citizenship or immigration status will be required upon employment.

Yes

If you are under 18 years of age, can you provide required proof of your legal eligibility to work?

Yes

Have you ever been employed with us before?

Yes, if yes, give date

Are you currently employed?

Yes

May we contact your present employer?

Yes

Not Applicable

Are you available to work (check all that apply):

Full Time

Part Time

Shift Work

Per Diem

Have you been convicted of a crime?
NOTE: A conviction will not necessarily disqualify you from employment. Full disclosure is expected. If hired omitted or misleading information will be grounds for dismissal.

Yes, if yes, please explain

Are you able to perform the essential functions of the job as described with or without reasonable accommodations?

Yes

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

EDUCATION

Please make sure that each section is filled out, do not write “please see resume”.

High School

Name and Address of School:
Course of Study:
Number of Years Completed:
Diploma or Degree:

Undergraduate College

Name and Address of School:
Course of Study:
Number of Years Completed:
Diploma or Degree:

Graduate Professional

Name and Address of School:
Course of Study:
Number of Years Completed:
Diploma or Degree:

Other (Specify)

Name and Address of School:
Course of Study:
Number of Years Completed:
Diploma or Degree:

Describe any job-related training received in the United States Military:

EMPLOYMENT EXPERIENCE

Please make sure that each section is filled out, do not write “please see resume”. Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer 1

Name and Address of Employer:
Telephone Number :
Job Title
Supervisor:
Dates Employed:	From: To:
Hourly Rate/Salary:	Starting: Final:
Work Performed:
Reason for Leaving:

Employer 2

Name and Address of Employer:
Telephone Number :
Job Title
Supervisor:
Dates Employed:	From: To:
Hourly Rate/Salary:	Starting: Final:
Work Performed:
Reason for Leaving:

Employer 3

Name and Address of Employer:
Telephone Number :
Job Title
Supervisor:
Dates Employed:	From: To:
Hourly Rate/Salary:	Starting: Final:
Work Performed:
Reason for Leaving:

Other Qualifications

Summarize special job-related skills and qualifications acquired from employment or other experience.

REFERENCES (please include 2 professional references)

Reference 1

Name of Reference:
Address:
Telephone Number:
Relationship to you:

Reference 2

Name of Reference:
Address:
Telephone Number:
Relationship to you:

Reference 3

Name of Reference:
Address:
Telephone Number:
Relationship to you:

RESUME

You may submit a resume by clicking on the link below and emailing it to our HR department: humanresources@shalomhouseinc.org

APPLICANT'S STATEMENT

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment.

I hereby understand and acknowledge that, any employment relationship with Shalom House, Inc. is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of Shalom House, Inc.

By entering your name in the box below, you are agreeing to the statement above. You will also be asked to hand-sign the same statement in the event you are interviewed.

I, , agree with the above statement.

Today's Date: