Evolution Homes for Children and Youth

Employment Application

Section 1: Applicant Information

Full Name:

Home Address:

Number of Years at this Address:

City:

State:

ZIP:

Daytime Phone:

Evening Phone:

Email Address:

Social Security Number:

Driver's License (State & Number):

Are you eligible to work in the U.S.? YesNo

Are you 18 or older? YesNo

When can you start?

What hours can you work?

Section 2: Emergency Contact

Contact Name:

Daytime Phone:

Evening Phone:

Section 3: Job Position and Role

Position Applying For:

Desired Salary:

Section 4: Availability

If offered employment, when can you start?

Why do you want to work here?

Section 5: Applicant's Employment History

Employer Name:

Position Held:

Start Date:

End Date:

Reason for Leaving:

Section 6: Applicant's Education and Training

High School Name:

High School Address:

Year Graduated:

College Name:

College Address:

Year Graduated:

Degree:

Section 7: Applicant's Background Checks

Have you ever been convicted of a felony?

If yes, please provide details (e.g., date, nature of the offense, and jurisdiction):

Have you ever been convicted of a misdemeanor?

If yes, please provide details (e.g., date, nature of the offense, and jurisdiction):

Are there any pending criminal charges against you?

If yes, please explain:

Have you ever been investigated by Child Protective Services (CPS)?

If yes, please provide details of the investigation (e.g., date, reason, and outcome):

Have you ever had a finding of abuse or neglect substantiated against you?

If yes, please explain:

Are you currently listed on a child abuse/neglect registry in any state?

If yes, please specify the state(s):

Have you ever had a professional license revoked, suspended, or sanctioned?

If yes, please provide details (e.g., type of license, date, and reason):

Have you ever been terminated or disciplined by an employer for misconduct or violations of policies?

If yes, please explain:

Are you currently prohibited by law from working in the industry or field for which you are applying?

If yes, please explain:

Have you ever been disqualified from employment due to background check findings?

If yes, please provide details:

Section 8: References

Name:

Relationship:

Phone:

Name:

Relationship:

Phone:

Certification

I certify that the information provided on this application is truthful and accurate.

I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize Evolution Homes for Children and Youth (EHFCY) to contact former employers and educational organizations regarding my employment and education.

I authorize my former employers and educational organizations to communicate information fully and freely regarding my previous employment, attendance, and grades.

I authorize those persons designated as references to communicate information fully and freely regarding my previous employment and education.

Applicant Signature:

Date:

By submitting this form you agree to the terms of the Privacy Policy.

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Evolution Homes for Children and Youth

Employment Application

Section 1: Applicant Information

Section 2: Emergency Contact

Section 3: Job Position and Role

Section 4: Availability

Section 5: Applicant's Employment History

Section 6: Applicant's Education and Training

Section 7: Applicant's Background Checks

Section 8: References

Certification

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