APPLICATION FOR EMPLOYMENT



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APPLICATION FOR EMPLOYMENT

Florence Housing Authority, 110 South Cypress Street, Suite 1, Florence, AL 35630-5551

Phone: 256-740-5206 Fax: 256-768-3175

E-Mail: rrichardson@ WEB Address:

Florence Housing Authority is an equal opportunity employer. Florence Housing Authority does not discriminate and no question on this application is used for the purpose of limiting or excluding any applicant’s consideration for employment on a basis prohibited by local, state, or federal law. Florence Housing Authority considers applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a disability, or any other legally protected status.

|Equal access programs, services, and employment are available to all persons. Those requiring reasonable accommodations to the application |

|and or interview process should notify Rhonda F. Richardson, or an authorized representative of Florence Housing Authority. |

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|Position applied for: Type of employment desired: Full Time Part Time Temp |

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|Last Name: First: Middle: |

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|Address City State Zip|

|Code |

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|Telephone Number: ( ) Alternate Telephone Number: ( ) |

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|Email Address: |

Do you live in a FHA community? _____Yes _____No

Are you a Section 8 participant? _____Yes _____No

Have you ever been employed by FHA? _____Yes _____No

If yes please list dates and positions _________________________________________________

Do you have any relatives currently employed by FHA? _____Yes _____No

Do you have any personal acquaintances currently employed by FHA? _____Yes _____No

Are you a U. S. citizen? _____Yes _____No

If no, a copy of your authorization to work issued by the United States Immigration Service must be attached to this application

Date available for work ___/____/_______

Have you ever plead “Guilty” or “no contest” to, or been convicted of a crime? _____Yes _____No

If yes, please provide date(s) and details___________________________________________

ANSWERING “YES” TO THE ABOVE QUESTIONS DOES NOT CONSTITUTE A BAR TO EMPLOYMENT. FACTORS SUCH AS DATE OF THE OFFENSE, SERIOUSNESS AND NATURE OF THE VIOLATION, REHABILITATION, AND POSITION APPLIED FOR WILL BE TAKEN INTO ACCOUNT

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EDUCATION

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|School Name/Address |Years Completed |Graduate |Degree/Diploma |Major |

| | |Yes/No | | |

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| |1 2 3 4 | | | |

| | | | | |

| |1 2 3 4 | | | |

| | | | | |

| |1 2 3 4 | | | |

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| |1 2 3 4 | | | |

In the space below please provide any additional training, license, or certifications that you have. Please list type of license/certificate/certification, issuing state or organization, number, and expiration date. As well as any additional skills that would make you an asset to the company.

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Driver License #________________State___________ Class:______________ Exp. Date:

NOTE: License must be available for copying

REFERENCES:

|NAME |ADDRESS |OCCUPATION |PHONE |

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PREVIOUS EMPLOYMENT: Please list past employment history starting with the most recent employer.

|Company Name: |Telephone: ( ) |

|Address: |Employment Dates: |

|Supervisor: |Salary: |

|Job Title & Details of job duties: |Reason for leaving: |

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|Company Name: |Telephone: ( ) |

|Address: |Employment Dates: |

|Supervisor: |Salary: |

|Job Title & Details of job duties: |Reason for leaving: |

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|Company Name: |Telephone: ( ) |

|Address: |Employment Dates: |

|Supervisor: |Salary: |

|Job Title & Details of job duties: |Reason for leaving: |

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|Company Name: |Telephone: ( ) |

|Address: |Employment Dates: |

|Supervisor: |Salary: |

|Job Title & Details of job duties: |Reason for leaving: |

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|APPLICANT STATEMENT |

I certify that answers given herein and any given during the interview process are true and complete to the best of my knowledge.

I authorize investigation of all statement contained in this application for employment as may be necessary in arriving at an employment decision. The employer has my authorization to thoroughly investigate my work, medical and personal history that is job related. I will hold not person, organization or corporation liable for giving or receiving information in this investigation. This application for employment shall be considered active for a period of time not to exceed six (6) months, unless otherwise indicated by the employer in writing. Any applicant desiring to be considered for employment beyond the indicated time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that unless otherwise defined by applicable law, any employment relationship with Florence Housing Authority is of a “at will” nature, which means that the Employee may resign at any time and that Florence Housing Authority may discharge an Employee at any time with or without cause. It is further understood that the “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an additional executive of the organization.

I understand that as part of the pre-employment process, Florence Housing Authority will conduct an in-depth background investigation in an effort to determine my suitability to fill the position for which I have applied. In the event of my employment, I authorize Florence Housing Authority to investigate to determine if I owe any outstanding debts to Florence Housing Authority. In keeping with the efforts of Florence Housing Authority to identify the most qualified individuals, I will voluntarily consent to a sampling and subsequent testing of my bodily fluids, including urine and blood, or other accepted methods of testing. I understand that the results of the testing may be utilized in conjunction with any other information developed during the pre-employment process to determine my eligibility for the position for which I have applied. Any doctor, hospital or testing laboratory may conduct medical tests and I hereby give my consent to have all information released in order for Florence Housing Authority to determine my abilities to perform job duties now or in the future.

In the event of employment, I understand that false or misleading information given in my resume, application or interview(s) may result in discharge, I understand that I am required to abide by all rules and regulations of Florence Housing Authority. If employed, I understand that my employment is for no definite period of time, and if terminated, Florence Housing Authority is only liable for wages and salary earned as of the date of termination.

I further that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and the State of Alabama, and that federal immigration laws require me to complete an I-9 Form in this regard.

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|DO NOT SIGN UNTIL YOU HAVE READ AND UNDERSTAND |

|THE ABOVE APPLICANT STATEMENT |

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|I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement. |

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|Signature of Applicant Date / / . |

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