Employment / Volunteer

Employment / Volunteer Application

Please Fill in the Following Fields

Name:

First

Last

Maiden Name:

Date of Birth:

Address:

Street AddressCityState Postal / Zip Code

Daytime Phone:

Area Code

-

Phone Number

Evening Phone:

Area Code

-

Phone Number

Are you Applying for:

A Volunteer Position

A Full Time Position

A Part Time Position

A Contract

1/8

Yes

No

What Year Will you Graduate From High School?:

Did you Graduate from High School?:

Yes

No

What Year Did You Graduate From High School?:

Did you Earn a Diploma or A GED?

Diploma

GED

Yes

No

What Year Will You Graduate From College?:

What Degree Will You Earn:

Did You Graduate from College?:

Yes

No

What Year Did you Graduate From College?:

What Degree do you Hold?:

Employer 1 Street AddressEmployer 1 CityEmployer 1 State Employer 1 Zip Code

Employment History

Employer #1

Complete form for at least 1 Employer

1 Place of Employment:

1 Employer Contact:

First Name

Last Name

1 Employer Phone:

Area Code

-

Phone Number

Reason for Leaving Employer 1:

Employer #2

This Employer is Optional, You may select Next to Skip

2 Place of Employment:

2 Employer Address:

Street AddressCityState Zip Code

2 Employer Contact:

First

Last

2 Employer Phone:

Area Code

-

Phone Number

2 Reason for Leaving:

Employer #3

This Employer is Optional, You may select Next to Skip

3 Place of Employment:

3 Employer Address:

Street AddressCityState Zip Code

3 Employer Contact:

First

Last

3 Employer Phone:

Area Code

-

Phone Number

3 Reason for Leaving:

Enter 3 References along with their phone numbers

1 Reference Name:

First

Last

1 Reference Phone:

Area Code

-

Phone Number

2 Reference Name:

First

Last

2 Reference Phone:

Area Code

-

Phone Number

3 Reference Name:

First

Last

3 Reference Phone:

Area Code

-

Phone Number

NON-DISCRIMINATION: The Family Healing Center, Inc. (FHC) does not discriminate against any person in the provision of services or in any other manner on the grounds of race, color, ethnicity, creed, religion, sex, national origin, sexual orientation, gender identity, citizenship, marital status, familial status, ancestry, age, disability or veteran status. If you feel like you have been discriminated against by FHC, please contact the Executive Director immediately at 606.548.1502.

CONFIDENTIALITY/PERMISSION STATEMENT: By signing below, I hereby state that all of the information on this application is true, correct and complete to the best of my knowledge. I also give FHC the right to check my criminal background information. I hereby agree to assure the confidentiality of other program participants and applicants at FHC. I understand and agree that my application and file may be reviewed by FHC funders and any other funders who have a legitimate interest.

I Agree

Applicants Electronic Signature

First

Last