Application - Dorothy's House.org

Position(s) applying for:

First Name *

Last Name *

Phone

Email *

Address *

City *

State *

Zip Code *

Employment Position

How did you hear about this position?

What days are you available for work? *

On what date can you start working if you are hired? *

Do you have reliable transportation to and from work? *

Yes

No

Are you a U.S. citizen or approved to work in the United States? *

Yes

No

What document can you provide as proof of citizenship or legal status?

Will you consent to a mandatory controlled substance test? *

Yes

No

Have you ever been convicted of a criminal offense (felony or misdemeanor)? *

Yes

No

If yes, please state the nature of the crime(s), when and where convicted and disposition of the case:

Job Skill/Qualifications

(Note: SCKCI, Inc. DBA Dorothy's House complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.)

Education and Training

High School Name

Location

Year Graduated

Degree Earned

College/University

Location

Year Graduated

Degree Earned

Vocational School/Specialized Training

Location

Year Graduated

Degree Earned

Are you a member of the Armed Services?

Yes

No

If yes, what branch of the military did you enlist?

What was your military rank when discharged?

How many years did you serve in the military?

What military skills do you possess that would be an asset for this position?

Previous Employment

Employer Name

Employer Phone

Job Title

Supervisor Name

Employer Address

City

State

Zip Code

Employer Name

Employer Phone

Job Title

Supervisor Name

Employer Address

City

State

Zip Code

Employer Name

Employer Phone

Job Title

Supervisor Name

Employer Address

City

State

Zip Code

References

Please provide 3 personal and professional reference(s) below.

Reference One

Contact Information

Reference Two

Contact Information

Reference Three

Contact Information

At-Will Employment

The relationship between you and the SCKCI, Inc. DBA Dorothy's House is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or SCKCI, Inc. DBA Dorothy's House. No representative of SCKCI, Inc. DBA Dorothy's House has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company President.

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