Employee Application - Mission on the Bay

Employment Application

This Company is an Equal Opportunity Employer and will not discriminate against any applicant on the basis of any characteristic that is protected by State or Federal Law.

Full Name:*

E-mail*

Phone:*

Date:

Present Street Address:*

City:*

State:

Emergency Contact:

Emergency Phone number:

Any offer of employment is conditioned upon completing an I-9 Form and providing documents establishing identity and work authorization. Mission on the Bay uses the government’s e-verification system to verify I-9 information.

Are you a citizen of the U.S. or do you have a legal right to work in the U.S.?*

Position applying for:*

Full Time
Part Time

Would you be interested in any other position(s)::*

Salary desired:

Have you previously applied for employment with Mission on the Bay?

Do you have any friends, relatives, or acquaintances working for Mission on the Bay?

If Yes, Name & Relationship:

Date available for employment:*

Are you 18 years of age or older?*

Name and city of last school attended:

Graduated?

Degree Type:

Major:

GPA:

Are you presently enrolled in school?

If yes, give name and city of school:

Availability

Day
Night

List any other education, accomplishments or special interests that would benefit you in this position:

Total hours per week available for work:

Availability A.M.:

Monday Day
Tuesday Day
Wednesday Day
Thursday Day
Friday Day
Saturday Day
Sunday Day

Availability P.M.:

Monday Night
Tuesday Night
Wednesday Night
Thursday Night
Friday Night
Saturday Night
Sunday Night

Employment History

List three present and past employment beginning with the most recent. Use additional pages as necessary.

Company Name and Address:

Dates of employment:

From:

To:

Immediate supervisor:

Phone:

Pay rate at beginning and end of employment:

Beginning:

Ending:

Job Title:

May we contact this employer?

Yes
No
Yes, at a later date

Reason for leaving: (If applicable)

Company Name and Address:

Dates of employment:

From:

To:

Immediate supervisor:

Phone:

Reason for leaving: (If applicable)

Pay rate at beginning and end of employment:

Beginning:

Ending:

Job Title:

May we contact this employer?

Yes
No
Yes, at a later date

Reason for leaving: (If applicable)

Company Name and Address:

Dates of employment:

From:

To:

Phone:

Reason for leaving: (If applicable)

Pay rate at beginning and end of employment:

Beginning:

Ending:

Job Title:

May we contact this employer?

Yes
No
Yes, at a later date

Reason for leaving: (If applicable)

Can you perform, with or without reasonable accommodation; the essential functions of this job (if you have any questions about the functions of this job, please ask the interviewer before answering this question)?

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Mission on the Bay any employment relationship with the Company is considered “employment at will,” which means the Employee may resign at any time and the Employer may discharge the Employee at any time, with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by any conduct unless such change is specifically executed by the Company President/CEO. I have read, understand and agree to the above statement.*