Application For Employment - Springs Rescue Mission



Springs Rescue Mission5 West Las Vegas Street ● Colorado Springs, Colorado 80903 ● (719) 632-1822 ● Application For EmploymentDate FORMTEXT ?????Name FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Phone FORMTEXT ?????(Last)(First)(Middle)Address FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????(Street)(City)(State) (Zip)Email Address FORMTEXT ?????If you are under 18 years of age can you provide a work permit? FORMCHECKBOX Yes FORMCHECKBOX NoPosition(s) applying for FORMTEXT ?????How did you learn of this opening? FORMTEXT ?????Date available for work FORMTEXT ?????Type of employment desired (check all that apply): FORMCHECKBOX Full-time FORMCHECKBOX Part-time FORMCHECKBOX Evenings FORMCHECKBOX Days FORMCHECKBOX Weekends FORMCHECKBOX Nights FORMCHECKBOX seasonal FORMCHECKBOX TemporaryAVAILABILITY: Please indicate the times that you are usually available for work.SundayMondayTuesdayWednesdayThursdayFridaySaturday FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Education InformationLevel of school you completed: FORMCHECKBOX Elementary FORMCHECKBOX Middle School FORMCHECKBOX High School FORMCHECKBOX 2 Yrs. College FORMCHECKBOX 4 Yrs. College FORMCHECKBOX Post-GradDid you complete high school?: FORMCHECKBOX Yes FORMCHECKBOX No DIPLOMA? FORMCHECKBOX Yes FORMCHECKBOX No GED? FORMCHECKBOX Yes FORMCHECKBOX No Name of last high school attended FORMTEXT ?????City & State FORMTEXT ?????Major FORMTEXT ????? Are you currently a student? FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Full Time FORMCHECKBOX Part Time Other FORMTEXT ????? If you are a student, what is your current status? FORMCHECKBOX Freshman FORMCHECKBOX Sophomore FORMCHECKBOX Junior FORMCHECKBOX Senior Explain FORMTEXT ????? Are you planning to pursue further studies? FORMCHECKBOX Yes FORMCHECKBOX No List other certifications, licenses, or specialized training: NameCity/StateCourse of StudyYears AttendedDid you GraduateDegreeCertificationCollege FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Business,Tech or Trade FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Employment HistoryList below your last four employers. Please begin with your current or most recent job first.1. EMPLOYER FORMTEXT ?????Phone Number FORMTEXT ?????Address FORMTEXT ?????Job Title FORMTEXT ?????Dates of Employmentfrom FORMTEXT ?????to FORMTEXT ?????(mm/yyyy)(mm/yyyy)Salarystart FORMTEXT ????end FORMTEXT ?????Describe your duties and responsibilities FORMTEXT ?????Supervisor FORMTEXT ?????Phone/Ext. FORMTEXT ?????Title FORMTEXT ?????Reason for leaving FORMTEXT ?????2. EMPLOYER FORMTEXT ?????Phone Number FORMTEXT ?????Address FORMTEXT ?????Job Title FORMTEXT ?????Dates of Employmentfrom FORMTEXT ?????to FORMTEXT ?????(mm/yyyy)(mm/yyyy)Salarystart FORMTEXT ?????end FORMTEXT ?????Describe your duties and responsibilities FORMTEXT ?????Supervisor FORMTEXT ?????Phone/Ext. FORMTEXT ?????Title FORMTEXT ?????Reason for leaving FORMTEXT ?????3. EMPLOYER FORMTEXT ?????Phone Number FORMTEXT ?????Address FORMTEXT ?????Job Title FORMTEXT ?????Dates of Employmentfrom FORMTEXT ?????to FORMTEXT ?????(mm/yyyy)(mm/yyyy)Salarystart FORMTEXT ?????end FORMTEXT ?????Describe your duties and responsibilities FORMTEXT ?????Supervisor FORMTEXT ?????Phone/Ext. FORMTEXT ?????Title FORMTEXT ?????Reason for leaving FORMTEXT ?????4. EMPLOYER FORMTEXT ?????Phone Number FORMTEXT ?????Address FORMTEXT ?????Job Title FORMTEXT ?????Dates of Employmentfrom FORMTEXT ?????to FORMTEXT ?????(mm/yyyy)(mm/yyyy)Salarystart FORMTEXT ?????end FORMTEXT ?????Describe your duties and responsibilities FORMTEXT ?????Supervisor FORMTEXT ?????Phone/Ext. FORMTEXT ?????Title FORMTEXT ?????Reason for leaving FORMTEXT ?????Please write the number(s) of any employer(s) you do not want us to contact FORMTEXT ?????If your name has changed or you have gone by another name during any periods of employment, please list name(s): FORMTEXT ?????Can you, upon employment, provide genuine documentation establishing identity and eligibility to be legally employed in the United States? FORMCHECKBOX Yes FORMCHECKBOX NoReferencesList one spiritual reference (#1), one professional reference (#2), and one personal reference (#3) none of whom are related to you.NameEmail AddressPhone NumberOccupationYears Known#1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????#2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????#3 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Please use the space below to share your Christian testimony: FORMTEXT ?????Applicant’s CertificationI hereby certify that the information contained in this application form is true and correct to the best of my knowledge and agree to have any of the statements checked by Springs Rescue Mission (SRM) or any of its agents unless I have indicated on this form to the contrary.I understand and agree that:Any misrepresentation, falsification, or material omission of information on this application may result in my failure to receive an offer or, if I am hired, in my dismissal from employment.All offers of employment are conditioned on the provision of satisfactory proof of an applicant’s identity and legal authority to work in the USA.A routine inquiry may be made during the processing of this application and I authorize SRM and their representatives to consult with administrators/supervisors/references and academic institutions with which I have been associated and with others who may have information bearing on my professional competence. I release from liability SRM as well as any and all individuals, corporations or organizations for furnishing such information.I understand that because Springs Rescue Mission is a Christian ministry organization whose purpose is to share the gospel of Jesus Christ; employment with SRM is subject to acceptance, agreement, and subscription to the Statement of Faith.In consideration of my employment, I agree to conform to the rules and standards of Springs Rescue Mission and that my employment and compensation can be terminated AT WILL, with or without cause, and with or without notice, at any time, either at my option or at the option of SRM. FORMTEXT ????? FORMTEXT ?????(Signature) FORMTEXT ?????(Date) FORMTEXT ????? Please type name above is submitting application electronically. Springs Rescue Mission is a 501(c)3, charitable, non-profit, Christian organization. As such, SRM exercises our legal rights as it relates to discrimination because of religious beliefs under a BFOQ. It is the policy of SRM to grant equal opportunities for employment to all qualified individuals without regard to race, color, sex, age, national origin, or non-job related handicap or disability. For Springs Rescue Mission Use OnlyApplication received by: ______________________________________Date: _______________________________Routed to: ____________________________ Date: ____________________ Position: _______________________________Routed to: ____________________________ Date: ____________________ Position: _______________________________Routed to: ____________________________ Date: ____________________ Position: _______________________________Hired? YES ___ NO ___Position: _____________________________Start Date: _________________________COMMENTS: ................
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