Employment
We appreciate your interest in becoming a member of the Positive Steps team!
Employment Application
( * = required field
)
Applicant Information
* Full Name:
* Address:
* City:
* St:
* Zip:
* Phone:
* Email:
Date Available
Desired Salary:
$
Social Security No.:
Position Applied for:
Do you have reliable personal transportation?
Yes
No
US Citizen?
Yes
No
If no, are you authorized to work in the US?
Yes
No
Have you ever worked for this company?
Yes
No
If yes, when?
* Have you ever been convicted of a felony?
Yes
No
If yes, explain:
Education
* High School:
Address:
From:
To:
* Did you Graduate?
Yes
No
Diploma:
College:
Address:
From:
To:
Did you Graduate?
Yes
No
Diploma:
Other:
Address:
From:
To:
Did you Graduate?
Yes
No
Diploma:
References
Please list three professional references
* Full Name:
Relationship:
Company
Phone:
Address
* Full Name:
Relationship:
Company
Phone:
Address
* Full Name:
Relationship:
Company
Phone:
Address
Previous Employment
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary: $
Ending Salary: $
Responsibilities:
From:
To:
Reason for leaving:
May we contact your previous supervisor for a reference?
Yes
No
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary: $
Ending Salary: $
Responsibilities:
From:
To:
Reason for leaving:
May we contact your previous supervisor for a reference?
Yes
No
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary: $
Ending Salary: $
Responsibilities:
From:
To:
Reason for leaving:
May we contact your previous supervisor for a reference?
Yes
No
Military Service
Branch:
From:
To:
Rank at Discharge
Type Discharge:
If other than honorable, explain:
Disclaimer
By submitting this form, I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.