Application for Employment

Fill out this form, print and send to your local chapter. Click HERE for addresses.

[Discrimination on this organization because of race, religion, sex, national origin, age, sexual preference, handicap, or political affiliation or belief are prohibited. Applicants may notify organizational officials or the appropriate local, state, or Federal agency if they believe that they have been victims of discrimination]

Address 1:
City, State, zip:
Home phone:
How were you referred?
Please describe why you would want to work with our organization
How long are you willing to commit yourself to working for our organization? months years
How much money do you need per month to live on?
Have you ever been convicted of a felony? no
if yes, what?
Are you currently employed? no
if yes, by whom and what position?

How long have you been with your current employer? yrs mos
Previous employer and reasons for leaving that employer?
Please provide whatever information you thing would be helpful in considering you for employment, including additional work experience, activities, accomplishments, skills, etc.

Name Address Phone Business #Yrs known

Applicant's Representations for employment:

Should I be employed by your organization, I agree to conform to your organization's rules and regulations, and agree that as an at-will employee, my employment and compensation can be terminated, at any time, for any or now reason, with or without notice, at the option of either the your organization or myself.

I certify that the information provided on this application is true and complete to the best of my knowledge and agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for termination if discovered at a later date.

This application has been read by me in its entirety.

Please sign and date: