Employment Application – C. Waldo Scott Center for H.O.P.E.

Employment Application Form

First Name *

Last Name *

Email Address *

Address *

Phone Number *

Alternative Phone Number

Applying For Position As: *

Were you previously employed by us? *

Yes

If yes, when? *

Are you legally eligible for employment in the U.S.A.? *

Yes

Are you at least 18 years of age? *

Yes

References

List three (3) persons (not former employers or relatives):

Reference #1 Name *

Reference #1 Address *

Reference #1 Business & Position *

Reference #1 Phone Number *

Reference #2 Name *

Reference #2 Address *

Reference #2 Business & Position *

Reference #2 Phone Number *

Reference #3 Name *

Reference #3 Address *

Reference #3 Business & Position *

Reference #3 Phone Number *

Education

Elementary/Middle School Name

Last Grade Completed

Name of High School

Last Grade Completed

College/University

Course of Study

List Diploma or Degree

Last Year of College Completed

Other (Please Specify)

Employment History

Fill out the fields below, or you may upload your resume.

Click here to upload your resume

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OR, enter your information below. List below all present and past employment, beginning with your most recent:

Company #1

Name of Company/Type of Business

Company Phone Number

Business Address

Employment Begin Date

Employment End Date

Position

Name of Supervisor

Reason for leaving:

Company #2

Name of Company/Type of Business

Company Phone Number

Business Address

Employment Begin Date

Employment End Date

Position

Name of Supervisor

Reason for leaving:

Company #3

Name of Company/Type of Business

Company Phone Number

Business Address

Employment Begin Date

Employment End Date

Position

Name of Supervisor

Reason for leaving:

As an adult, if you have been convicted of a misdemeanor or felony other than a minor traffic violation, please list date and nature of offense:

Have you been convicted of any offense involving the sexual molestation, physical or sexual abuse, or rape of a child? *

Yes

If yes, explain. *

Please Sign Below

The answers to the foregoing questions are true and correct to the best of my knowledge. I understand that as part of normal employment procedures, a routine inquiry may be made concerning information on my character, general reputation, credit, and work history. I authorize such investigation and understand that, upon written request, information as to the nature and scope of the inquiry, if one is made, will be provided. *

Physical Location:
2308 Roanoke Avenue
Newport News, VA 23607

Mailing Address:
P.O. Box 36
Newport News, VA 23607

Phone:
757-244-9223

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