Employment Application

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PERSONAL INFORMATION

First Name *

Last Name *

Phone *

Cell Phone

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

How long at current address? *

Previous Address *

Address Line 1

Address Line 2

City

State

Zip Code

How long at previous address? *

Email *

Are you over the age of 18? *

Yes
No

Are you a citizen of the United States? *

Yes
No

Emergency Contact: Name *

Relationship to Applicant *

Phone *

Languages you can speak, read, and write fluently: *

Have you ever been convicted of a crime other than a minor traffic violation? *

Yes
No

If yes, please explain:

EMPLOYMENT INFORMATION

What position are you applying for? *

Available start date: *

Salary/hourly rate expected: *

Are you available: *

Full-Time
Part-Time
Temporary

Have you ever applied for employment with us before? *

No
Yes

Have you ever been employed with us before? *

Yes
No

If yes, what year/s?

What prompted you to apply? *

Our Purpose
Friend
Church
Other

If other, please briefly explain:

EDUCATION HISTORY

High School: *

City: *

State: *

College: *

City *

State *

Degree: *

EMPLOYMENT HISTORY

List your present or most recent employer first and work backward. Please give accurate, complete, full-time and part-time information. If you do not possess all this information, we strongly encourage you to obtain it for your application materials. Incomplete information may delay or disqualify your application for employment.

Name of most recent employer: *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Employed From (Month/Year): *

To (Month/Year): *

Name while employed: *

Position held: *

Responsibilities: *

Name and position of immediate supervisor: *

Starting pay rate (USD): *

Final pay rate (USD): *

Reason for leaving: *

Name of previous employer: *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Employed From (Month/Year): *

To (Month/Year): *

Name while employed: *

Position held: *

Responsibilities: *

Name and position of immediate supervisor: *

Starting pay rate (USD): *

Final pay rate (USD): *

Reason for leaving: *

EMPLOYMENT HISTORY CONTINUED

Name of previous employer: *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Employed From (Month/Year): *

To (Month/Year): (copy) *

Name while employed: *

Position held: *

Responsibilities: *

Name and position of immediate supervisor: *

Starting pay rate (USD): *

Final pay rate (USD): *

Reason for leaving: *

Provide ANY ADDITIONAL INFORMATION (attached resume acceptable) you believe will help us regarding your experience and/or other special qualifications not listed elsewhere in this application: *

REFERENCES

Employer 1 *

Please provide reference name, phone number, email address, and relationship.

Employer 2 *

Please provide reference name, phone number, email address, and relationship.

Personal 1 *

Please provide reference name, phone number, email address, and relationship.

Personal 2 *

Please provide reference name, phone number, email address, and relationship.

PERSONAL RELATIONSHIP WITH JESUS CHRIST

It is our desire that all employees feel comfortable within the Christian environment here at the Orlando Union Rescue Mission. Because of the unique nature and purpose of our organization, all employees are expected to be able to share with business associates, guests and visitors his or her experience of having a personal relationship with Jesus Christ.

Please give a brief statement of your personal relationship with Jesus Christ and how it began. *

Name of place of worship: *

Present level of church involvement: *

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Signature: *

Date: *