Application for Employment

Application for Employment

The Civil Rights Act prohibits discrimination in employment because of race, color, gender, religion, sexual orientation or national origin. The Age Discrimination Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age, but less than 70. Title 1 provisions of the American With Disabilities Act of 1990 prohibits discrimination against qualified individuals with disabilities in job procedures.

Click here to see what job positions are available with Bella Alternative Homes.

First Name:		Last Name:
Phone: (daytime)		Phone: (night)
Today's Date :		Start Date :
Address:		Unit#
City:		State:
Zip:		Email:
Position Desired		Requested Wages:	$

Social Security #		Drivers License # (if applicable to position)

Are you a citizen of the United States?		If not, are you legally able to work in the United States?
Have you ever plead "guilty," "no-contest," or been convicted of a crime?		If yes, please give dates and details:


Type of Employment
Seasonal	Temporary	Full Time	Part Time

Availability
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Employment History
Most Recent or Previous Employer:		Dates Employed:	to
Address:		Phone #:
Supervisor:		Title:
Describe Position & Duties:		Wages:	Start $ End $
Reason for leaving:		May we contact?

Employer:		Dates Employed:	to
Address:		Phone #:
Supervisor:		Title:
Describe Position & Duties:		Wages:	Start $ End $
Reason for leaving:		May we contact?

Employer:		Dates Employed:	to
Address:		Phone #:
Supervisor:		Title:
Describe Position & Duties:		Wages:	Start $ End $
Reason for leaving:		May we contact?

Education	# of years completed
High School:		Areas of Study:
Vocational/Trade School:		Areas of Study:
Under Grad:		Areas of Study:
Grad School:		Areas of Study:
	Additional Training or information relevant to position applied for:

Acknowledgement (Please read carefully)

I hereby certify that the information contained in this application form and in any attachments listed below (hereafter made a part of this application) is true and correct to the best of my knowledge and agree to have any of the statements checked by the organization and affiliates unless I have indicated to the contrary. I authorize the references listed above to provide any and all information concerning my previous employment and any pertinent information that they may have. Further I release all parties, affiliates and persons from any and all liability for any damages that may result from furnishing such information as well as from the use or disclosure of such information by the organization or any of its affiliates, agents, employees, or representatives. I understand that any misrepresentation, falsification, or material omission of information on this application may result in my failure to receive an offer or, if I am hired, in my dismissal from employment.

Agree or Disagree

Initial

Bella Alternative Homes; Providing a loving home environment and prevocational training to adults with special needs.