Lend-A-Hand Senior Services

Employment Application

Lend-A-Hand Senior Services does not discriminate in hiring or employment on the basis of race, color, religion, gender or ancestry or on the basis of age or physical or menal handicap unrelated to ability to perform the work required. No question on this application is intended to secure information to be used for such discrimination. This application will be given every consideration however, its completion does not imply that the applicant will be employed.

PERSONAL INFORMATION:














If you cannot be reached at the above phone number, is there a secondary phone number available?



If not a United States citizen, do you have the legal right to remain permanetly and work in the U.S?

Yes
No



Have you ever worked for Lend-A-Hand Senior Services?

Yes
No

Are you currently employed?

Yes
No

May we contact your present employer?

Yes
No

If NOT please explain why:



EMPLOYMENT DESIRED:


Can you work weekends?

Yes
No

Weekend Availability:




Weekday Availability:







Can you work a 24-hour shift?

Yes
No

Days and times that you are NOT available:


Do you drive?

Yes
No



Do you have a realiable car to go to work?

Yes
No

Do you limit your annual income due to Social Security or other reasons?

Yes
No

If yes, please enter the maximum amount you wish to earn:


EDUCATION:



Did you graduate?

Yes
No

If answered no to graduating, do you have a GED?

Yes
No



EMPLOYMENT HISTORY:

Please list last or present employer first.

1)







Dates of Employment:





Reason for leaving:


2)







Dates of Employment:





Reason for leaving:


3)







Dates of Employment:





Reason for leaving:


Personal References


Please list two personal references that we may contact.







Why should we consider you to serve seniors in our community?