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Employment Application

First Name
Middle Initial
Last Name
Address
City
Zip
State
Email
Home Phone
Cell Phone
Social Security Number
   
Are you over 18?
Yes No
Date of birth
Have you worked for Victory before?
Yes No
 
If yes, dates/location(s)
Reason for leaving
 
 

AVAILABILITY

Hours Available:
  M T W T F S S
From
To
Total hours available per week
 
Are you legally able to be employed in the U.S?
Yes No
Do you have transportation?
How did you hear about this employment opportunity?
How far do you live from our office?

 

EMPLOYMENT HISTORY:

If not applicable, list work performed on a volunteer basis or personal references. Please attach a separate list of employers if more space is needed.
May we contact your present employer?
Yes No
 
EMPLOYER 1.
Company
 
Address
City
Zip
State
Phone
Job
Supervisor
Dates Worked:
From
To
Rate of Pay
Reason For Leaving
MGMT. Reference Check Done By
 
EMPLOYER 2.
Company
 
Address
City
Zip
State
Phone
Job
Supervisor
Dates Worked:
From
To
Rate of Pay
Reason For Leaving
MGMT. Reference Check Done By
 
EMPLOYER 3.
Company
 
Address
City
Zip
State
Phone
Job
Supervisor
Dates Worked:
From
To
Rate of Pay
Reason For Leaving
MGMT. Reference Check Done By
 

SCHOOL MOST RECENTLY ATTENDED:

Name
   
Street Address
City
Zip
State
Phone
Teacher or Counselor we may contact as a reference
Dept.
Last Grade Completed
Grade Point Average
Graduated?
Yes No
Now Enrolled?
Yes No
 
 

U.S MILITARY:

Branch of Service
   
Date Entered
Date Discharge
Highest Rank
 
Do you have service-related skills and experience applicable to civilian employment?
Yes No
If yes, describe
 

GENERAL:

What other relevant experience or training have you had and what other activities are you involved in? (Exdude organizations that indicate race, religion, age, or national origin of members.)
   
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