Personal Information Name Address Email Home Phone Mobile Phone Are you eligible to work in the U.S? YesNo Are you at least 18 years or older? (If no, you may be required to provide authorization to work.) YesNo Have you ever been terminated from employment or asked to resign by an employer? YesNo If yes, please provide company names and details Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation? YesNo Employment Desired Date you can start Hourly Rate/Salary desired Position desired Are you currently employed? YesNo If so, may we inquire of your present employer? YesNo Referral Source How did you hear about us? Walk-InAdvertisementReferralOther Have you ever worked for this company before? YesNo If yes, please explain. Do you know anyone who works for our company? YesNo If yes, who? Education Name and Location of School Number of Years Attended Degree Received Subjects Studied/Major High School College Trade, Business, or Correspondence School Employment History Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration. From To Employer Name Telephone Job Title Address Immediate Supervisor and Title Summarize the nature of work performed and job responsibilities Reason for Leaving From To Employer Name Telephone Job Title Address Immediate Supervisor and Title Summarize the nature of work performed and job responsibilities Reason for Leaving From To Employer Name Telephone Job Title Address Immediate Supervisor and Title Summarize the nature of work performed and job responsibilities Reason for Leaving From To Employer Name Telephone Job Title Address Immediate Supervisor and Title Summarize the nature of work performed and job responsibilities Reason for Leaving Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for? YesNo If yes, explain. Computer Skills (Please describe): References Give the names of three persons not related to you, whom you have known at least three (3) years. Name Address, Phone, Email Company Years Acquainted Please read carefully before signing. The Woonsocket Housing Authority is an equal opportunity employer. The Woonsocket Housing Authority does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service. I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for the Woonsocket Housing Authority to hire me. If I am hired, I understand that either the Woonsocket Housing Authority or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of the Woonsocket Housing Authority Name has the authority to make any assurance to the contrary. I attest with my signature below that I have given to the Woonsocket Housing Authority true and complete information on this application. No requested information has been concealed. I authorize the Woonsocket Housing Authority to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal. I agree to the above stated conditions. Please enter your full legal name which will serve as your digitial signature: Date THIS APPLICATION IS VALID ONLY FOR 90 DAYS FROM THE DATE SIGNED/DATED ABOVE.
