Application for Employment

Employment Policy
Urban Settlement Services is an equal opportunity employer and does not discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to employment, services, and programs is avaliable to all persons. Those applicants requiring reasonable accomodation to the application and/or interview process should notify a representative of this company.

Authorization
I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, references, and educational institutions. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.

If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either | or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no applicable federal or state law.

I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that person's need for a reasonable accomodation as required by the ADA.

I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.

Personal Information
* Name (First, Middle, Last):
Present Address
* Email Address:
SSN:
* Phone:	- -
Desired Employment
Position Desired:
Type of employment	Full TimePart Time Temporary
Date available to start (MM/DD/YY):
Are you able to meet the attendance requirements?	Yes No
Do you have any objection to working overtime?	Yes No
Can you travel if required by this position?	Yes No
Have you ever been previously employed by Urban Settlement Services, Inc.?	Yes No
May we contact your present employer?	Yes No
Have you been convicted of a crime in the past 7 years?	Yes No
If YES, please explain (a conviction will not automatically bar employment)
Prior Employment
Please list your past four employers, starting with the most recent
Employer 1
Month/Year From (MM/YY):
Month/Year To (MM/YY):
Name and Address of Employer:
Salary:
Position:
Reason for Leaving:
Employer 2
Month/Year From (MM/YY):
Month/Year To (MM/YY):
Name and Address of Employer:
Salary:
Position:
Reason for Leaving:
Employer 3
Month/Year From (MM/YY):
Month/Year To (MM/YY):
Name and Address of Employer:
Salary :
Position:
Reason for Leaving:
Employer 4
Month/Year From (MM/YY):
Month/Year To (MM/YY):
Name and Address of Employer:
Salary:
Position:
Reason for Leaving:
Education
High School
Name and Location of School:
Graduated?	Yes No
Major Area of Study:
College
Name and Location of School:
Graduated?	Yes No
Major Area of Study:
Other School
Name and Location of School:
Graduated?	Yes No
Major Area of Study:
Summarize any job-training, skills, licenses, certificates, and/or other qualifications.
References
Reference 1
Name and Occupation:
Phone	- -
Email Address:
Years Known:
Reference 2
Name and Occupation:
Phone:	- -
Email Address:
Years Known:
Reference 3
Name and Occupation
Phone:	- -
Email Address:
Years Known:
Additional
Provide any additional information that will assist us in our evaluation of your application.
Sign & Date Form
This is only required if you are filling this out in paper form. Applicant's Signature: _________________________Application Date: ___________