All applicants are considered for all positions without regard to race, color, creed, religion, sex, national origin, citizenship status, ancestry, age, marital status, veteran status, physical or mental disability, pregnancy, medical condition, sexual orientation, or any other legally protected status. By completing this application, you are seeking to join a team of hardworking professionals dedicated to consistently delivering outstanding service to our customers and contributing to the financial success of the company, its clients, and its employees. Equal access to programs, services and employment is available to all qualified persons. Those applicants requiring accommodation to complete the application and/or interview process should contact a management representative. 

Position applied for: *
Name *
Name
Phone *
Phone
Your Current Address *
Your Current Address
EMPLOYMENT EXPERIENCE
Please list the names of your present or previous employers in chronological order with present or last employer listed first. Be sure to account for all periods of time including military service and any period of unemployment. If self-employed, give firm name and supply business references. [Add additional page if necessary]
Starting Date of Employment *
Starting Date of Employment
Ending Date of Employment *
Ending Date of Employment
Put today's date if you are currently employed.
$
$
Supervisor Name *
Supervisor Name
Next Employer
Starting Date of Employment
Starting Date of Employment
Ending Date of Employment
Ending Date of Employment
$
$
Supervisor Name
Supervisor Name
EDUCATION
Please describe your educational background in the table provided below.
High School
Which years completed?
College/University
Graduate/Professional
BUSINESS/PROFESSIONAL REFERENCES
PLEASE INCLUDE: NAME, TITLE, BUSINESS RELATIONSHIP, AND PHONE NUMBER.
CO-WORKER REFERENCES
PLEASE INCLUDE: NAME, OCCUPATION, RELATIONSHIP (Example: Worked together at ABC Company for 3 years), YEARS ACQUAINTED, PHONE NUMBER
GENERAL INFORMATION
On what date are you available to begin work? *
On what date are you available to begin work?
Are you available to work... *
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Note: If under 18, hire is subject to verification that you are of minimum legal age.
Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for qualified applicants/employees to perform essential job functions.
Do not include minor traffic infractions, any convictions for which the record has been sealed or expunged, any conviction for which the conviction has been judicially dismissed, referrals to and participation in any pretrial or post-trial diversion programs, any determination in the juvenile justice system; a conviction more than 7 years old, and misdemeanor marijuana-related offenses that occurred over two years ago in answering these questions. Answering "Yes" to question 15 does not constitute an automatic bar to employment. Factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account.
MINISTRY APPLICATION
This is a confidential application to be completed by all applicants for any position at the Visalia Rescue Mission
Please include church name, address, length of attendance, and any ministries in which you are involved.
APPLICANT STATEMENT AND AGREEMENT
_____ I hereby authorize the Company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to the Company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure. _____ In the event of my employment with the Company, I understand that I am required to comply with all rules and regulations of the Company. I understand that the Company reserves the right to require me to submit to a test for the presence of drugs or alcohol in my system prior to employment and at any time during my employment, to the extent permitted by law. I voluntarily submit to the drug and/or alcohol screening and understand that the presence of drugs or alcohol in my system may disqualify me from further consideration of employment with this company, or may result in termination of my employment with the company. _____ I understand that any offer of employment may be contingent upon the passing of a physical examination. I consent to the disclosure of the results of the physical examination and related tests to the Company. I understand that should I decline to sign this consent or take any of the above tests, my application for employment may be rejected. I understand that bonding may be a condition of hire. If it is, I will be so advised either before or after hiring and a bond application will have to be completed. _____ I understand that I may be required to take other tests such as personality and honesty tests, prior to and during my employment. I understand that should I decline to sign this consent or take any of the above tests, my application for employment may be rejected or my employment may be terminated. _____ If hired, I understand and agree that my employment with the Company is at-will, and that neither I, nor the Company is committed to continuing the employment relationship for any specific term. I further understand that the Company or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by oral statements or in any other way, but can only be altered by written amendment signed by the Owner/President of this Company. _____ I understand that safety of employees is extremely important to the Company and that the Company is committed to ensuring a safe working environment. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my site supervisor. I understand and agree to comply with federal, state, and local regulations related to on-the-job safety and health. I also recognize that an effective safety program extends beyond normal working hours. Safety should be promoted within the family and in off-the-job activities. I understand and agree to adhere to safety practices while performing my job. A copy of the Injury and Illness Prevention Plan will be provided to me upon my request. _____ I understand that my employment will be contingent upon signing the Company’s Alternative Dispute Resolution Agreement (if applicable), a copy of which will be provided with the Employee Handbook packet. _____ I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. _____I hereby certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. _____ I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration laws require me to complete an I-9 Form in this regard. _____I understand It is my responsibility to verify that the state and federal payroll tax deductions taken on my payroll checks match the information I provided on my completed W-4 form. _____ I understand that if any term, provision, or portion of this Agreement is declared void or unenforceable, it shall be severed and the remainder of this Agreement shall be enforceable.

By submitting this application, you attest to the fact that you have read, understand, and agree to be legally bound to all of the above terms. 

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.