Equal Opportunity Employer - Connecticut Housing Partners
Equal Opportunity Employer
Connecticut Housing Partners is an equal opportunity employer to qualified individuals regardless of race, color, religious creed, age, sex, marital status, civil union, national origin, ancestry, physical or mental disability, mental retardation, learning disability, sexual orientation, genetic information, or any other legally protected class in accordance with all applicable laws.
**** P L E A S E P R I N T I N B L A C K O R B L U E I N K ****
Personal Identification
______________________________________ ____________________________________
Name (Last, First, Middle Initial) Telephone (Home)
______________________________________ ____________________________________
Address (City, State, Zip Code) Telephone (Work or Cell)
______________________________________ ___________________________________
Date of Birth Social Security Number
General Information
Position Desired______________________________ When Can You Start?__________________________
Salary Desired_______________________________
Type of employment desired? Full Time □ Part Time □
Have you ever been terminated from any job? Yes □ No □ If yes, why? _________________________________________________________________________________________
_________________________________________________________________________________________
Are you legally eligible to work in the U.S.? Yes □ No □
Have you served in the military? Yes □ No □ If yes, what branch of the military________________
What is your current military status? Active □ Reserve (Active) □ Reserve (Inactive) □
Please list any other name(s) that you may have used in the past so that we may verify your work or educational
records. _____________________________________________________________________________________
Do you have a driver’s license in good standing? Yes □ No □
If no, please explain___________________________________________________________________________
State Issued_______________________ Driver’s License Number _____________________________________
Education Information
| | | | |
|Name and Address of School |Dates Attended |Did You Graduate |Degree/Major |
|High School |To___________ |Yes □ No □ | |
| |From__________ | | |
|Vocational /Business School |To___________ |Yes □ No □ | |
| |From__________ | | |
|College |To___________ |Yes □ No □ | |
| |From__________ | | |
|Graduate School |To___________ |Yes □ No □ | |
| |From__________ | | |
| | | | |
Special Skills or Qualifications:
________________________________________________________________________________________
_____________________________________________________________________________________
Professional Memberships/Certifications/Licenses:
__________________________________________________________________________________________
__________________________________________________________________________________________
Professional, Trade, Business or Civic Associations (exclude memberships which would reveal sex, race, religion, national origin, age, color, disability or other protected status)
_________________________________________________________________________________________
________________________________________________________________________________________
Employment History
List all previous employers starting with present or most recent. Account for all time for the last 10 years. Include periods of self employment, part-time and other jobs.) If more space is needed, attach a separate sheet of paper. Please complete all sections. Please attach resume to this form if available.
_____________________________________ _____________________________ _______________________
Name of Employer Address/City/State/Zip Employment Start/End
____________________________________ _____________________________
Employer Telephone Title or Position
May we contact your present employer? Yes □ No □_____________________________________
Employment History (continued)
_____________________________________ _____________________________ _______________________
Name of Employer Address/City/State/Zip Employment Start/End
____________________________________ _____________________________
Employer Telephone Title or Position
May we contact your present employer? Yes □ No □ ________________________________________
Name/Title of Immediate Supervisor
Description of Work/Responsibilities ______________________________________________________________
Employment History (continued)
_____________________________________ _____________________________ _______________________
Name of Employer Address/City/State/Zip Employment Start/End
____________________________________ _____________________________
Employer Telephone Title or Position
May we contact your present employer? Yes □ No □ _____________________________
Name/Title of Immediate Supervisor
Description of Work/Responsibilities_____________________________________________________________
Employment History (continued)
_____________________________________ _____________________________ _______________________
Name of Employer Address/City/State/Zip Employment Start/End
____________________________________ _____________________________
Employer Telephone Title or Position
May we contact your present employer? Yes □ No □ __________________________
Name/Title of Immediate Supervisor
Description of Work/Responsibilities____________________________________________________________
Professional/Work References
Please list the names of two professional and one personal reference who have knowledge of your qualifications, skills and abilities.
|Name/Title |Relationship |Address/City/State/Zip |Telephone No./Email |
| | | | |
| | | | |
| | | | |
| | | | |
I hereby certify that the information provided on this application is true, correct and complete to the best of my knowledge. I understand that any material misrepresentation or deliberate omission of fact on this application may be sufficient cause to justify refusal of employment or once employed, may be cause for termination of employment. I understand that my employment may be contingent upon receipt of alien registration number, verification of birth and other pertinent information relating to my employment with Connecticut Housing Partners formerly MHASWCT. I further understand that my employment with Connecticut Housing Partners formerly MHASWCT is “at will” and may be terminated at any time with or without notice by myself or the employer.
_____________________________________________ _________________________
Applicant Signature Date
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