Employment – Safe Harbor Housing

Name(Required)

First Middle Last Suffix

Address(Required)

Street Address Address Line 2 City State ZIP / Postal Code Country

Phone(Required)

Email(Required)

Date of Application(Required)

Position applying for:(Required)

How did you hear about this postion?(Required)

What days are you available to work?(Required)

On what days can you start working if you are hired?(Required)

Salary desired?(Required)

Do you have any friends, relative, or acquaintances working for Bayou La Batre Housing Authority?

Yes

If yes, state name and relationship

Are you a US Citizen or approve to work in the United State?(Required)

Yes

What document can you provide as proof of citizenship or legal status?(Required)

Will you commit to a mandatory controlled substance test?(Required)

Yes

Do you have any condition which would require job accomodations?(Required)

Yes

If yes. please describe accommodations required below:

Have you ever been convicted of a criminal offense (felony or misdemeanor)?(Required)

Yes

If yes, please state the nature of the crime(s), when and where convicted and disposition of the case:

Please list below the skills and qualifications you possess for the position for which you are applying:

Note: Bayou La Batre Housing Authority complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.)

EDUCATION & TRAINING

Name of High School

Location (City, State)

Year Graduated

Degree Earned

College/University Name of School

Location (City, State)

Year Graduated

Degree Earned

Vocational School/Specialized training

Location (City, State)

Year Graduated

Degree Earned

Are you a member of the Armed Services?(Required)

Yes

Which branch of the military did you enlist?

What was your military rank when discharged?

How many years did you serve in the military?

What military skills do you possess that would be an asset for this position?

EMPLOYMENT EXPERIENCE

Employer

Job Title

Supervisor Name

Employer Address

Street Address Address Line 2 City State ZIP Code

Employer Phone

Dates Employed

Reason for leaving?

Employer

Job Title

Supervisor Name

Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employer Phone

Dates employed

Reason for Leaving

Employer

Job Title

Supervisor Name

Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employer Phone

Dates employed

Reason for Leaving

REFERENCES

Name(Required)

Contact Info(Required)

Name(Required)

Contact Info(Required)

Name(Required)

Contact info(Required)

AT-WILL EMPLOYMENT

The relationship between you and the Bayou La Batre Housing Authority 1s referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Bayou La Batre Housing Authority. No representative of Bayou L Ba e Housing Authority has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge hat no oral or written statements or representations regarding your employment can alter your at-wiII employment status, except for a written statement signed by you and either our Executive Vice-President Chief Operations Officer or the Company's President.

Signature(Required)

Date(Required)

Employment Application

EDUCATION & TRAINING

EMPLOYMENT EXPERIENCE

REFERENCES

AT-WILL EMPLOYMENT

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