My Brother's House, Inc – My WordPress Blog



APPLICATION FOR EMPLOYMENT

My B.R.O.T.H.E.R.S. House, Inc.

4822 Albemarle Road Suite 105 Charlotte, NC 28205

Office: (704)532-4771 Fax: (704)532-4774

PERSONAL

|Last Name First Middle |Maiden Name |

|Street Address City, State, Zip |Home Telephone: |

| |Cell Telephone: |

|Social Security: Date of Birth: |Business Telephone: |

|Email: |License Number: |

|Are you related to anyone now working for MBH Inc? Yes () No () |

|If yes, whom:__________________________ Relationship: __________________________ |

|Have you ever applied for employment with us? Yes ( ) No ( ) If yes, year ______________ |

|Are you legally eligible for employment in the United States? |

|Are you 25 years or older? Yes ( ) No ( ) |

|When are you available to begin work? |

|Have you been a resident of North Carolina for the past 5 years? Yes ( ) No ( ) |

POSITION(S) DESIRED

| | | |

EDUCATION AND TRAINING (Please include copy of transcripts, originals will be required upon employment)

|School |Name/Location |Date Attend |Graduate? |Course of Study |Type of Degree Received|

| | | |Yes/No | | |

|High School | | | | | |

|College or University | | | | | |

|Business Technical | | | | | |

|Graduate | | | | | |

|Other special training or skills (languages, machine operation, etc.) |

|__ Sign Language __ Foreign Language (specify __________) __ Braille Skills __ Dictation |

|__ Medical Transcription __ Typing (specify wpm ____) __ Calculator __ Shorthand |

|Software (Circle): Word ( ) Excel ( ) Desktop Publishing ( ) Other: ________________________________ |

|List fields of work for which you are licensed, registered, or certified: |

|Registration __________________________________ State _________ Number _____________ Date _______ |

|Registration __________________________________ State _________ Number _____________ Date _______ |

MEMBERSHIP IN PROFESSIONAL OF CIVIC ORGAGNIZATIONS

| |

Applicant Name: _______________________

EMPLOYMENT HISTORY (Please give accurate, complete full time and part time employment history, start with your present or most recent employer). SEE RESUME is not acceptable.

|Current or Last Employer: |Job Title: |

|Address: |Starting Salary |

|Supervisor: |Telephone: |

|Reason for Leaving: |May we contact employer? Yes ( ) No ( ) |

|Employed (state month /year) |List duties:____________________________________ |

|Full Time: From: ___________ |______________________________________________ |

|To: _____________ |______________________________________________ |

|Part Time: From: ___________ |______________________________________________ |

|To: _____________ |If supervisor responsibility, number of employees supervised by you: |

|If part time, hours per week? ( ) |_____________________________ |

| Employer: |Job Title: |

|Address: |Starting Salary |

|Supervisor: |Telephone: |

|Reason for Leaving: |May we contact employer? Yes ( ) No ( ) |

|Employed (state month /year) |List duties:____________________________________ |

|Full Time: From: ____________ |______________________________________________ |

|To: ______________ |______________________________________________ |

|Part Time: From: ____________ |If supervisor responsibility, number of employees supervised by you: |

|To: ______________ |_____________________________ |

|If part time, hours per week? ( ) | |

|Employer: |Job Title: |

|Address: |Starting Salary |

|Supervisor: |Telephone: |

|Reason for Leaving: |May we contact employer? Yes ( ) No ( ) |

|Employed (state month /year) |List duties:____________________________________ |

|Full Time: From: ____________ |______________________________________________ |

|To: ______________ |______________________________________________ |

|Part Time: From: ____________ |If supervisor responsibility, number of employees supervised by you: |

|To: ______________ |_____________________________ |

|If part time, hours per week? ( ) | |

|Employer: |Job Title: |

|Address: |Starting Salary |

|Supervisor: |Telephone: |

|Reason for Leaving: |May we contact employer? Yes ( ) No ( ) |

|Employed (state month /year) |List duties: ___________________________________ |

|Full Time: From: ____________ |______________________________________________ |

|To: ______________ |______________________________________________ |

|Part Time: From: ____________ |If supervisor responsibility, number of employees supervised by you: |

|To: ______________ |_____________________________ |

|If part time, hours per week? ( ) | |

Describe your three best attributes. What do you likes about yourself?

1.

2.

3.

What is your personal history or background that is a source of pride to you?

What would your last employer tell us about you?

What would be the perfect job for you?

What do you want to be doing in five years?

_____________________________________________________________________________________________

Have you ever been convicted of an offense against the law other than a minor traffic violation? (A conviction does not mean you cannot be hired. The offense and how recently you were convicted will be evaluated in relation to the job for which you are applying). ______Yes _____No (If yes, explain fully on an additional sheet.)

Have you ever been convicted of a felony? ____ Yes ____ No

Have you ever applied for Worked Compensation? ____ Yes ____ No If so, why? ______

_____________________________________________________________________________________________

Have you served in U.S. Armed Forces? _______ Yes ______No

if yes, were you discharged honorably? _______ Yes ______No

Are you member of the Military Reserves? _____Yes ______No

_____________________________________________________________________________________________

Do you have any medical conditions that would prohibit you from performing at My Brothers House, Inc? Example: Pregnancy, back problems, pacemaker, stroke within the last five years. (A medical condition does not mean you will not be hired.) _________Yes ___________No If so, what condition?_________________________________

Check the type of work you will accept:

___ Permanent Full-Time ___Permanent Part-Time __ Temporary Full-Time

___ Temporary Part – Time ___ Work Involving Travel __ Shift or Split Shift Work

___ Any of the Above

Salary Expectations: $ ________________________

From whom or where did you learn of our agency and this vacancy? ____________________________

_____________________________________________________________________________________________

typical work activities may include changes in work location, position, duties assigned and work schedules which best fit current needs. No condition of employment is guaranteed, but is subject to change as to best fit the needs of the agency and the customers served. At some point in your “at will” employment you may be directly involved in this type of activity.

Potential Employee:

As a prerequisite of employment with My Brother’s House Inc. it is necessary for YOU to request a MVR (Driver’s License/Driving Record Check). Current licensing privilege and past driving history must be received in order for us to better determine certain details of employment requirements / insurance coverage with My Brother’s House Inc.

___ I will give My BROTHERS House, Inc a copy of the MVR with my current licensing privileges and Driving Record History.

___ I will not give My BROTHERS House, Inc. a copy of the MVR with my current licensing privileges and Driving Record History.

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