Application for Employment

You may complete this online application, or download this PDF to complete and return offline.

Personal Information
Position(s) applied for:
I am available to work:
- Full Time
- Part Time
- Temporary
- Weekends
- Evenings
Date of Application:
Date Format: MM slash DD slash YYYY
Name
First Middle Last
Primary Phone No.:
Alternative Phone No.:
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Are you eligible to work in the United States?
- Yes
- No
(Proof of eligibility will be required upon offer of employment.)
Date available to begin employment:
Date Format: MM slash DD slash YYYY
Salary Desired
Employment History
List below your last three employers, starting with the most recent employer.
Present or Last Position
Name of Company
Dates of Employment (Month/Year):
From
Date Format: MM slash DD slash YYYY
to
Date Format: MM slash DD slash YYYY
Company Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Starting Salary
Final Salary
Bonus (if applicable):
Commission (if applicable);
May we contact your supervisor?
- Yes
- No
Name of Supervisor
First Last
Supervisor's Title and Department
Supervisor's Phone Number
Supervisor's Email Address
Reason for Leaving
Present or Last Position
Name of Company
Dates of Employment (Month/Year):
From
Date Format: MM slash DD slash YYYY
to
Date Format: MM slash DD slash YYYY
Company Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Starting Salary
Final Salary
Bonus (if applicable):
Commission (if applicable);
May we contact your supervisor?
- Yes
- No
Name of Supervisor
First Last
Supervisor's Title and Department
Supervisor's Phone Number
Supervisor's Email Address
Reason for Leaving
Present or Last Position
Name of Company
Dates of Employment (Month/Year):
From
Date Format: MM slash DD slash YYYY
to
Date Format: MM slash DD slash YYYY
Company Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Starting Salary
Final Salary
Commission (if applicable);
Bonus (if applicable):
May we contact your supervisor?
- Yes
- No
Name of Supervisor
First Last
Supervisor's Title and Department
Supervisor's Phone Number
Supervisor's Email Address
Reason for Leaving
Skills and Qualifications
- Office Admin
Years
- Sales
Years
- Management
Years
- Deconstruction
Years
- Warehouse
Years
- Driving
Years
- Cashier
Years
- Other
Please Describe
Years
Education Information
High School or GED
Address
Street Address City State / Province / Region
Diploma?
- Yes
- No
Graduation Year
College
Address
Street Address City State / Province / Region
Degree/Year
Major
GPA
Graduate School
Address
Street Address City State / Province / Region
Degree/Year
Major
GPA
Other
Address
Street Address City State / Province / Region
Major
GPA
Degree/Year
General
Identify any awards you’ve earned, training you’ve received, or certifications you did/do hold (with dates).
Please summarize why you would like to work for Second Chance.
References
Please list three people who know you but are not related to you or previous supervisors.
Reference 1 Name
First Last
Reference 1 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference 1 Phone
Reference 1 Relationship/Occupation
Reference 1 Years Known
Reference 2 Name
First Last
Reference 2 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference 2 Phone
Reference 2 Relationship/Occupation
Reference 2 Years Known
Reference 3 Name
First Last
Reference 3 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference 3 Phone
Reference 3 Relationship/Occupation
Reference 3 Years Known
Notification and Agreement
Please read thoroughly before signing.
I agree.
In making this application for employment, I authorize you to communicate with persons listed as references, former employers, and any others with whom you desire to check. I agree to hold such persons harmless with respect to any information they may give about me.

If employed, I agree to engage in no outside activity which would involve a material conflict of interest with, or which would reflect adversely on, Second Chance Inc. I understand this decision is to rest with Second Chance.

If I am employed, I agree to conform to the employment policies of Second Chance. I understand and acknowledge that unless otherwise defined by applicable law, any employment relationship with Second Chance is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge the Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written documentation or by conduct unless an authorized executive of this organization specifically acknowledges such change in writing.

I understand that completion of this Application for Employment does not guarantee that I have been or will be employed by Second Chance.

I hereby affirm that my answers to these statements and questions are true and correct to the best of my knowledge. I have not knowingly withheld any fact or circumstance that would, if disclosed, affect my application negatively.

I understand that any misrepresentation, deception, or false statement made in this Application for Employment may result in my not being considered for employment, and if not discovered by Second Chance until after I am employed, is grounds for, and may result in, my immediate termination.
Name
First Last
Date
Date Format: MM slash DD slash YYYY
Signature
Comments
This field is for validation purposes and should be left unchanged.

Application for Employment

Personal Information

Employment History

Skills and Qualifications

Education Information

General

References

Notification and Agreement

LOCATION/CONTACT

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