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APPLICATION POSITION: Credit and Housing Counselor

Personal Information

Last Name:

First Name:

Initial:

Current Address

Street Address:

Current Street Address 2:

City:

State:

Zip Code:

Previous Address

Street Address:

Previous Street Address 2:

City:

State:

Zip Code:

Please enter phone numbers in xxx-xxx-xxxx format

Cell Phone:

Home Phone:

E-mail:

Preferred Contact Method

Position Application

Position Applied for:

Salary:

Date Available:

Availability:

Full Time

Part Time

List days and hours available:

The restaurant industry occasionally requires overtime and often without advance notice; do you agree to work overtime if needed?

Yes

No

Have you or a relative ever worked for this company?

Yes

No

Do you have the legal right to work in the United States?

Yes

No

Are you at least 18 years of age:

Yes

No

Have you ever served in the U.S. Armed Services?

Yes

No

Have you ever been convicted of a felony?

Yes

No

Education

High School

Name and Location of School:

Years Completed:

9

10

11

12

Graduated?

Yes

No

College

Name and Location of School:

Major:

Years Completed:

1

2

3

4

Graduated?

Yes

No

Trade, Business or Correspondence School

Name and Location of School:

Major:

Years Completed:

Graduated?

Yes

No

Employment History

Current/Previous Job

Company:

Address:

Phone:

Job Title:

Final Rate of Pay:

Name of Supervisor:

Employed From:(date):

Employed To: (date):

Reason for Leaving:

Previous Job

Company:

Address:

Phone:

Job Title:

Final Rate of Pay:

Name of Supervisor:

Employed From:(date):

Employed To: (date):

Reason for Leaving:

Previous Job

Company:

Address:

Phone:

Job Title:

Final Rate of Pay:

Name of Supervisor:

Employed From:(date):

Employed To: (date):

Reason for Leaving:

Previous Job

Company:

Address:

Phone:

Job Title:

Final Rate of Pay:

Name of Supervisor:

Employed From:(date):

Employed To: (date):

Reason for Leaving:

PERSONAL REFERENCES
WHO ARE NOT RELATIVES OR FORMER EMPLOYERS

Name:

Address:

Phone:

Occupation:

Years Known:

Name:

Address:

Phone:

Occupation:

Years Known:

Name:

Address:

Phone:

Occupation:

Years Known:

I certify that all statements made by me on this application are true and complete

Additional Information

List any scholastic or work related awards you have received::

Do you have any special training or qualifications that you feel might be utilized in the position for which you are applying?

In a brief statement, explain why you would be a value adding addition to our Company?

Reliability and punctuality are extremely important to our Business. Do you have adequate and reliable transporation?

Schedule an Appointment

Affiliated with • Alliance of Information and Referral Systems • Council on Accreditation of Services for Families and Children • United Way of Southwest Alabama