Mission WV Employment Application

Applicant Information

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Date Available to Start Work

YYYY

Last 4 of your Social

Position Applied for

Are you authorized to work in the U.S.?

Have you ever been convicted of a crime?

If yes, please explain

Driving Information

Do you have reliable personal transportation?

Do you have a valid Driver’s License?

Education

High School Name

Did you graduate?

College Name

Dates attended

Did you graduate?

Degree

College Name

Dates attended

Did you graduate?

Degree

Other licenses, certificates, training, etc.:

Employment

Please list your three most recent places of employment starting with your current position.

Company

Position

City

Phone

(###)

###

####

Supervisors Name

Reason for leaving

Company

Position

City

Phone

(###)

###

####

Supervisors Name

Reason for leaving

Company

Position

City

Phone

(###)

###

####

Supervisors Name

Reason for leaving

Professional References

Please list three professional references.

Name

First Name

Last Name

Relationship

Company

Phone

(###)

###

####

Name

First Name

Last Name

Relationship

Company

Phone

(###)

###

####

Name

First Name

Last Name

Relationship

Company

Phone

(###)

###

####

Disclaimer and Signature – Please Read Carefully!

I certify that my answers are true and complete to the best of my knowledge. In exchange for the consideration of my job application, I agree that: Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other positions, shall serve to create an actual or implied contract of employment, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned. Both the undersigned and Mission West Virginia, Inc. may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the organization may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits. I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give Mission West Virginia, Inc. permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the organization from any liability as a result of employment. I further understand that my employment with the organization shall be probationary for a period of ninety (90) days, and further that at any time during the probationary period or thereafter, my employment relation with Mission West Virginia, Inc. is terminable at will for any reason by either party.

Signature

By typing your name here, you are electronically signing this application.

** Mission West Virginia, Inc. is an Equal Opportunity Employer. We adhere to a policy of making employment decisions without regard to race, gender, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this organization depends solely on your qualifications. **