Senior Monongalians, Inc. Employment Application

 

 

PLEASE READ THE FOLLOWING BEFORE COMPLETING OUR APPLICATION:

 

 

  1. There is no guarantee of a job offer or a job interview in completing our application.  Your application will be considered with others who have submitted applications and decision about interviews will be based on this comparison.

 

  1. Our application must be completely filled out in order for it to be considered for employment.

 

  1. If the information provided on our application cannot be satisfactorily verified by employment reference checks your application could be considered as incomplete.

 

  1. Applications are filed according to job title.  Be as specific as possible in stating the job applying for: ANY position is not an acceptable response on our application.

 

  1. Due to the large number of applications we receive and the competitive nature of our employment process, specific reasons for employment decisions will not be released.

 

  1. In completing our application blank you may/will be subject to the following checks:
    • EMPLOYMENT REFERENCE CHECK FROM FORMER EMPLOYERS
    • CRIMINAL RECORD CHECK
    • DRUG SCREEN

 

  1. Employees are paid by DIRECT DEPOSIT every 14 days.

 

 

 

 

 

 

____________________________________, I have read the above statements.

Signature of Applicant

 

 

SENIOR MONONGALIANS, INC.

P.O. BOX 653

MORGANTOWN, WV 26505

 

APPLICATION FOR EMPLOYMENT

 

FEDERAL AND STATE LAWS PROHIBIT DISCRIMINATION IN EMPLOYMENT BECAUSE OF SEX, AGE, RACE, COLOR, RELIGIOUS CREED, MARITAL STATUS, NATIONAL ORIGIN, ANCESTRY, CITIZENSHIP, LIABILITY FOR SERVICE IN THE ARMED FORCES OF THE UNITED STATES OR DISABILITY OR ANY OTHER PROTECTED CLASSIFICATION

 

DATE:  _____________________

 

PERSONAL INFORMATION                  TELEPHONE:  (______) ______ - ________

                                                                                                   AREA        NUMBER

 

NAME__________________________________________________________________

                        FIRST                          MIDDLE INITIAL                  LAST

 

PRESENT ADDRESS_____________________________________________________

                                     STREET                     CITY               STATE            ZIP CODE

 

HAVE YOU EVER WORKED UNDER ANOTHER NAME?    YES______ NO______

IF YES, WHAT NAME OR NAMES?   _______________________________________

 

HAVE YOU EVER WORKED FOR SENIOR MONONGALIANS, INC. BEFORE?

YES_____ NO_____  IF YES, DATES OF EMPLOYMENT AND REASON FOR LEAVING_______________________________________________________________

 

 

ARE YOU 18 YEARS OF AGE OR OLDER?  YES ______ NO ______

 

ARE YOU EITHER A U.S. CITIZEN OR AN ALIEN WHO HAS THE LEGAL RIGHT TO REMAIN AND WORK ING THE U.S.?  (YOU WILL BE REQUIRED TO FURNISH PROOF OF LAWFUL WORK STATUS IF YOU ARE EXTENDED A JOB OFFER.)                                                               YES ______ NO ______

 

HAVE YOUR EVER BEEN CONVICTED OF A CRIME?  YES ______ NO ______

IF SO, PLEASE DESCRIBE FULLY THE CRIMINAL CONVICTION(S), LISTING THE NATURE OF THE OFFENSE, THE DATE OF THE OFFENSE, AND YOUR REHABILITQATION SINCE THE CONVICTION(S). (A CONVICTION RECORD WILL NOT NECESSARILY BE A BAR TO EMPLOYMENT.)____________________

 

________________________________________________________________________________________________________________________________________________

EMPLOYMENT DESIRED

 

POSITION(S) APPLIED FOR: ______________________________________________

DATE YOU CAN START: _________________________________________________

                                                            MONTH                      DAY                YEAR

EMPLOYMENT AVAILABILITY:                     ______FULL TIME  ______PART TIME

                                               ______7AM-3PM  ______3PM-11PM  ______11PM-7AM

 

WHAT ARE YOUR EMPLOYMENT INTENTIONS:           ______LESS THAT 1 YEAR

                                                                                                ______1-2 YEARS                                                                                                                 ______ INDEFINITELY

 

SCHOOL                  YEARS ATTENDED               COURSE OF STUDY                 DEGREE/DIPLOMA               

HIGH SCHOOL

 

COLLEGES

 

OTHER SCHOOLS

 

 

 

EMPLOYMENT HISTORY

LIST BELOW YOUR WORK EXPERIENCE (STARTING WITH YOUR PRESENT OR MOST RECENT EMPLOYER) FOR THE LAST FIVE YEARS OR YOUR LAST THREE EMPLOYERS, WHICHEVER WILL PROVIDE US WITH THE GREATEST INFORMATION ABOUT YOU.  USE THE REVERSE SIDE OF THE APPLICATION FORM IF YOU NEED ADDITIONAL SPACE.  PLEASE ACCOUNT FOR ALL PERIODS OF UNEMPLOYMENT IN THIS SECTION.

 

 

DATES OF                      NAME & ADDRESS           NAME OF

EMPLOYMENT             OF EMPLOYER                       SUPERVISOR                   JOB TITLE               SALARY  

FROM: _______            ___________________        _________________   __________ START________

TO: __________           ___________________        _________________    __________ FINNISH ______             

 

TYPE OF BUSINESS ___________________________________________________________________

 

BRIEFLY DESCRIBE YOUR JOB DUTIES AND WORK EXPERIENCE:

 

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________REASON FOR LEAVING

 

______________________________________________________________________________________                      

________________________

 

DATES OF                      NAME & ADDRESS           NAME OF

EMPLOYMENT             OF EMPLOYER                       SUPERVISOR                   JOB TITLE               SALARY  

FROM: _______            ___________________        _________________   __________ START________

TO: __________           ___________________        _________________    __________ FINNISH ______             

 

TYPE OF BUSINESS ___________________________________________________________________

 

BRIEFLY DESCRIBE YOUR JOB DUTIES AND WORK EXPERIENCE:

 

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________REASON FOR LEAVING

 

______________________________________________________________________________________                      

________________________

 

DATES OF                      NAME & ADDRESS           NAME OF

EMPLOYMENT             OF EMPLOYER                       SUPERVISOR                   JOB TITLE               SALARY  

FROM: _______            ___________________        _________________   __________ START________

TO: __________           ___________________        _________________    __________ FINNISH ______             

 

TYPE OF BUSINESS ___________________________________________________________________

 

BRIEFLY DESCRIBE YOUR JOB DUTIES AND WORK EXPERIENCE:

 

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________REASON FOR LEAVING

 

______________________________________________________________________________________                      

________________________

 

**MAY WE SPEAK TO YOUR PRESENT EMPLOYER AT THIS TIME?

YES ______ NO ______

 

 

 

 

 

 

 

 

 

APPLICANT’S STATEMENT

            I understand that if employed by Senior Monongalians, Inc.(SMI), I will be an employee at-will, which means that I can voluntarily end my employment or be terminated at any time for any reason or no reason at all.  No statement whether written or oral, by any SMI representative other than a written statement signed by the Executive Director may vary the foregoing.  I give SMI permission to contact all or any of my previous employers and references and authorize them to provide all information requested of the by the SMI.  After a tentative offer of employment has been made, if requested by the SMI, I agree to take a job-related medical examination at no personal expense and authorize the examining physician to disclose the findings to SMI.  I understand that any offer of employment is conditioned upon receipt of satisfactory references and satisfactory completion of such job-related medical examination.

            I have provided truthful and complete responses to all inquiries in the application and understand that the discovery of any falsification or omission constitutes a ground for immediate dismissal.  If employed, I will abide by SMI’s rule and regulations, which understand are subject to change by SMI.

 

 

_____________________                            _____________________________________

DATE                                                            APPLICANT’S SIGNATURE

 

 

 

 

 

 

PROFESSIONAL AND CHARACTER REFERENCES (OTHER THAN RELATIVES)

NAME                                                 ADDRESS                                   PHONE NUMBER

1. _____________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

 

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION.

 

 

 

APPLICANT’S SIGNATURE

 

 

 

 

 

 

 

 

 

 

READ BEFORE SIGNING

I understand that Senior Monongalians, Inc. (SMI) insists that all of its employees by able to perform the essential functions of their employment as well as possess the character, integrity and general reputation for honesty that SMI would itself represent in its dealings with customers, suppliers and employees, among others.  Accordingly, SMI insists on complete honesty.

 

I, therefore, authorize SMI to make whatever inquiries it deems appropriate to verify any information given in my application and/or determine my qualifications and ability to perform the hob for which I am applying.  I understand that my consideration for employment is contingent upon the results of this background/reference investigation, including verification of previous assignments, education, military and criminal/law records; authentication of the truth of all statements made in this application; personal and professional reference checks, including inquiries into my character, work performance, general reputation and work habits; and if necessary, to secure a credit report, investigative and otherwise concerning my credit worthiness and other information permitted by state/federal law.  I EXPRESSLY HEREBY GIVE MY CONSENT FOR ALL CONTACTED PERSONS TO PROVIDE INFORMATION CONCERNING THIS APPLICATION AND I RELEASE EACH SUCH PERSON FROM LIABILITY FOR PROVIDING INFORMATION TO SENIOR MONONGALIANS, INC.

 

I hereby certify that the information contained in this application is correct to the best of my knowledge and I understand that falsification of this application in any detail, including misrepresentation or omission of facts, is grounds for disqualification from further consideration, or for dismissal from employment at a later date.  Furthermore I agree to conform to the rules and regulations of SMI and I UNDERSTAND THAT, IF HIRED, MY EMPLOYMENT WILL BE FOR NO DEFINITE PERIOD OF TIME, THAT I WILL BE AN EMPLOYEE AT-WILL, THAT I WILL BE FREE TO LEAVE EMPLOYMENT WITH SMI AT ANY TIME AND FOR ANY REASON AND THAT SMI MAY TERMINATE MYEMPLOYMENT AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE.  IUNDERSTAND THAT NOTHING IN ANY OF SMI’S WRITTEN POLICIES, HANDBOOKS, OR OTHER DOCUMENTS SHOULD BY CONTRACTUAL OBLIGATIONS ON THE PART OF SMI.  FURTHERMORE, I UNDERSTAND THAT NO ONE AT SMI IS AUTHORIZED TO MAKE ANY CONTRACT RELATIN TO MY EMPLOYMENT UNLESS THE CONTRACT IS SET IN WRITING AND IS SIGNED BY THE EXECUTIVE DIRECTOR OF SENIOR MONONGALINS, INC.

 

 

_____________________________________________                 __________________

Signature of Applicant                                                                                       Date