Employment Application

Please submit your application. Depending on position applying for, you may also send a cover letter and resume via e-mail to Employment@SafePlace.org

1. Last name, First name		*
Street Address or PO Box		*
City		*
State		*
Zip Code		*
Phone		*
Email		*
Position applying for		*
Have you ever been convicted of a felony?		*
If yes, please explain below.
Are you eligible for employment in the U.S.?		*
Driver's license number, state and expiration.
Dates available for employment
Salary required. Please list hourly and/or yearly salary.		*
Are you currently employed? If so, please list name and contact information for your current employer.		*
May we contact your current employer?
Highest Education Completed		*
Please list Names and locations of High School and Colleges attended
Are you fluent in a language besides English? Please list language and comment on your level of proficiency in speaking, reading and writing.		*
Employer #1 name and address
Dates of employment: From Month/Year to Month/Year
Your title or position
Brief job description
Ending Salary (monthly/yearly)
Employer # 2 name and address:
Dates of employment: From month/year to month/year
Your title or position
Brief job description.
Ending Salary (monthly/yearly)
Employer #3 name and address
Date of employment: From month/year to month/year
Your title or position.
Brief job description
Ending Salary (monthly/yearly)
Please tell us why you would like to work for SafePlace.		*
I agree that the information submitted is true, correct and complete. If employed, any misstatement or omission of fact on the application may result in dismissal.		*

I hereby understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future.