Job Application – Covenant Hands LLC

Application for Employment

It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex oreligion, national origin, disability or other protected classifications.

Please carefully read and answer all questions. You will not be considered for employment if you fail to completely answer all the questions on this application. You may attach a résumé, but all questions must be answered.

PERSONAL DATA

Prefix

First Name

Middle Name

Last Name

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Email Address

Home Telephone Number

Business Telephone Number

Cellular Telephone Number

Date you can start work

Desired Hourly Pay

USD

Do you have a High School Diploma or GED? *YesNo

POSITION INFORMATION

Check all that you are willing to work

Hours: *Full timePart time

Shift *DaysEvenings

Are you authorized to work in the U.S. on an unrestricted basis? *YesNo

Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment.) Yes No If yes, explain:

Have you been told the essential functions of the job or have you been viewed a copy of the job description listing the essential functions of the job?YesNo

Can you perform these essential functions of the job with or without reasonable accommodation? *YesNo

QUALIFICATIONS

Please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training.

School Name *

Degree *

Address/City/State *

College Name

Degree

Address/City/State

Other Institutions Name

Degree

Address/City/State

SPECIAL SKILLS (List any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc.)

May we contact your present employer? Yes No N/A *YesNo

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorise the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application.I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.

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