Application for Employment

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 INFORMATION
Name*
First Middle Last
Current Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Home
Phone
Mobile/Other
Email Address*
Are you 18 or over?*
- Yes
- No
Are 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.
- Yes
- No
Have 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.
- Yes
- No
ADDENDUM TO EMPLOYMENT APPLICATION
ADDENDUM 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 Information
Applicant Signature*
By completing this field, you are authorizing that the information provided above is correct and takes place of an official signature.
Date*
Month
Day
Year
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.

EMPLOYMENT HISTORY
Complete 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 Country
Start Date*
Month
Day
Year
End Date*
Month
Day
Year
Position Title*
Salary or Rate*
Supervisor's Name and Title*
Reason for Leaving*
Briefly describe your duties & responsibilities:*
Employer (2)
Employer
Phone
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Start Date
Month
Day
Year
End Date
Month
Day
Year
Position Title
Salary or Rate
Supervisor's Name and Title
Reason for Leaving
Briefly describe your duties & responsibilities:
Employer (3)
Employer
Phone
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Start Date
Month
Day
Year
End Date
Month
Day
Year
Position Title
Salary or Rate
Supervisor's Name and Title
Reason for Leaving
Briefly describe your duties & responsibilities:
Employer (4)
Employer
Phone
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Start Date
Month
Day
Year
End Date
Month
Day
Year
Position Title
Salary or Rate
Supervisor's Name and Title
Reason for Leaving
Briefly describe your duties & responsibilities:
Additional Information
In order to have a clear understanding of your background and work history, describe any additional directly related skills, abilities and experience:*

LICENSE or CERTIFICATION
If 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 Date
Has your license/certification ever been suspended/revoked/restricted or has a disciplinary investigation ever been conducted concerning your professional activities?*

Yes

No
If 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 Date
Military Service
Have you ever served in the Armed Forces?*

Yes

No
If yes, what Branch?
Are you currently a member of the National Guard?*

Yes

No

REFERENCES
Please list two (2) references other than relatives or former employers.
Reference (1)
Name*

Contact Information:*
address, phone, and/or email
In what capacity do you know this person?*
Reference (2)
Name*

Contact Information:*
address, phone, and/or email
In what capacity do you know this person?*

APPLICANT'S DECLARATION
Read 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 understand
If 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 understand
If 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 understand
I 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 understand
I 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 understand
If 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 understand
I 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 understand
I hereby release from liability Metro Interfaith and its representatives for seeking information and all other persons, corporations or organizations for furnishing such information.*

I understand
Applicant 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*
Month
Day
Year

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.

Elder and Disabled Housing – Binghamton, NY | Metro Interfaith Housing Management Corp.

Application for Employment

Step 1 of 7

PERSONAL INFORMATION

ADDENDUM TO EMPLOYMENT APPLICATION

POSITION APPLICATION

EMPLOYMENT HISTORY

Employer (1)

Employer (2)

Employer (3)

Employer (4)

Additional Information

EDUCATION

LICENSE or CERTIFICATION

Military Service

REFERENCES

Reference (1)

Reference (2)

APPLICANT'S DECLARATION

Metro Interfaith Housing Management Corp.

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