Application for Employment Application for Employment Step 1 of 7 14% All applicants are given equal consideration without regard to race, color, religion, gender, national origin, age, disability status, genetic disposition, gender orientation or identity, marital or military status or any other legally protected status. Metro Interfaith will make reasonable accommodations for individuals with disabilities during the application, interviewing and employment process. PERSONAL INFORMATIONName* First Middle Last Current Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*HomePhoneMobile/OtherEmail Address* Are you 18 or over?*YesNoAre you legally eligible to accept employment in the United States?*You will be required to furnish proof of lawful work status if you are extended an offer of employment.YesNoHave you ever been convicted of and/or plead guilty of a violation, misdemeanor or felony?*If yes, you must complete the Addendum to Employment Application. A conviction record may not necessarily be a bar to employment.YesNoADDENDUM TO EMPLOYMENT APPLICATIONADDENDUM TO EMPLOYMENT APPLICATION CONVICTION RECORD APPLICANT: If you answered yes and have been convicted of and/or plead guilty of a violation, misdemeanor or felony, please provide additional information such as date of offense, Court location, seriousness and nature of offense and sentence assigned or rehabilitation completed. What*(Describe the incident/offense):When*(Month/Year):Where*(City/State):Disposition*(Location of Court; Felony, Misdemeanor or Violation; Sentence):Other InformationApplicant Signature*By completing this field, you are authorizing that the information provided above is correct and takes place of an official signature.Date* MM DD YYYY NOTE: A conviction record is not necessarily a bar to employment. All factors related to the seriousness and nature of the offense and rehabilitation or sentence served will be taken into consideration. POSITION APPLICATIONPosition(s) Applying for*Salary Desired*Work Preference* Full-Time Part-Time/Hourly Temporary/Seasonal Are you available for weekend, holiday or on-call assignments?*YesNoDate available to start work?* Have you submitted an application with us within the previous 12 months?*YesNoHave you previously been employed by Metro Interfaith?*YesNoIf yes, please provide previous dates of employment:Do you currently have any family members employed by Metro Interfaith?*YesNoIf yes, please identify:How were you referred to Metro Interfaith for employment opportunities?* Friend/Relative Newspaper Website Referral Agency Other: Other:For reference purposes, do you object to us contacting your present or past employers?*YesNoIf yes, who? EMPLOYMENT HISTORYComplete this section for the previous 10 year period or at least three employers beginning with your current or most recent job. Include any directly related volunteer experience, military assignment and explain any periods of unemployment. Employer (1)Employer*Phone*Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Start Date* MM DD YYYY End Date* MM DD YYYY Position Title*Salary or Rate*Supervisor's Name and Title*Reason for Leaving*Briefly describe your duties & responsibilities:*Employer (2)EmployerPhoneAddress Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Start Date MM DD YYYY End Date MM DD YYYY Position TitleSalary or RateSupervisor's Name and TitleReason for LeavingBriefly describe your duties & responsibilities:Employer (3)EmployerPhoneAddress Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Start Date MM DD YYYY End Date MM DD YYYY Position TitleSalary or RateSupervisor's Name and TitleReason for LeavingBriefly describe your duties & responsibilities:Employer (4)EmployerPhoneAddress Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Start Date MM DD YYYY End Date MM DD YYYY Position TitleSalary or RateSupervisor's Name and TitleReason for LeavingBriefly describe your duties & responsibilities:Additional InformationIn order to have a clear understanding of your background and work history, describe any additional directly related skills, abilities and experience:* EDUCATIONSelect all that apply to your education background.* Highschool College Post College Trade School/Other High SchoolName & address of SchoolCourse of StudyDid you graduate?YesNoCollegeName & address of SchoolCourse of StudyDid you graduate?YesNoDiploma, Degree, or No of Credits EarnedPost CollegeName & address of SchoolCourse of StudyDid you graduate?YesNoDiploma, Degree, or No of Credits EarnedTrade School/OtherName & address of SchoolCourse of StudyDid you graduate?YesNoDiploma, Degree, or No of Credits Earned LICENSE or CERTIFICATIONIf a license, certificate or other authorization to practice a trade or profession is a requirement of the position for which you are applying, please complete the following:Type, Number, State or Licensing Agency & Expiration DateHas your license/certification ever been suspended/revoked/restricted or has a disciplinary investigation ever been conducted concerning your professional activities?*YesNoIf yes, please explain*If a motor vehicle license is a requirement of the position for which you are applying, please complete the following:License Number and Class, State Issuing & Expiration DateMilitary ServiceHave you ever served in the Armed Forces?*YesNoIf yes, what Branch?Are you currently a member of the National Guard?*YesNo REFERENCESPlease list two (2) references other than relatives or former employers.Reference (1)Name*Contact Information:*address, phone, and/or emailIn what capacity do you know this person?*Reference (2)Name*Contact Information:*address, phone, and/or emailIn what capacity do you know this person?* APPLICANT'S DECLARATIONRead and confirm your understanding of the following statements and sign and date below. I certify that the responses made in this application, including any attachments, are true and complete to the best of my knowledge.*I understandIf employed, I understand that any omission, misrepresentation and/or falsification of information given in this application or during the interview process may result in termination, regardless of the date discovered.*I understandIf employed, I agree to abide by all the rules and regulations of Metro Interfaith and relative to my position which I also understand may be subject to change by the organization.*I understandI authorize the investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision, including any applicable criminal background checks.*I understandI understand that this application is not intended to be a contract of employment. I further understand that Metro Interfaith follows the practice of employment-at-will.*I understandIf a conditional offer of employment has been made and if required, I agree to undergo a job-related physical examination at no personal expense and authorize the examining physician to release the results confidentially to Metro Interfaith’s Human Resources Department.*I understandI authorize Metro Interfaith to investigate all references and to secure additional job related information about me. I understand that any offer of employment is conditioned upon receipt of satisfactory references, satisfactory completion of job related medical examination and any applicable background checks.*I understandI hereby release from liability Metro Interfaith and its representatives for seeking information and all other persons, corporations or organizations for furnishing such information.*I understandApplicant Signature*By completing this field, you are authorizing that the information provided on this application is correct and takes place of an official signature.Date* MM DD YYYY Please note any other surnames (last names) by which you are or have been known.APPLICATIONS WILL BE HELD ON FILE FOR ONE YEAR FROM DATE OF APPLICATION.