Employment Application

Qualified applicants receive equal consideration. No question is asked for the purpose of excluding any applicant due to race, color, national origin, religion, age, sex, disability, veteran status or any other characteristic protected under local, state or federal law.

Contact Information

Name *

Address *

Address

City

State

Postal Code

Country

Home Phone

Cell Phone *

Email Address *

If under 18 years of age, do you have a work permit?

Do you have the right to remain in and work in the US? *

Have you ever worked for HS? *

Do you have any friends or relatives currently working for HS? If yes, name?

Position Applying For *

Availability

Availability *

Weekday mornings

Weekday afternoons

Weekday evenings

Weekday overnights

Weekend mornings

Weekend afternoons

Weekend evenings

Weekend overnights

Date available to start *

Education

Highest degree or level of school completed (check one box below) *

High school diploma or equivalent (e.g. GED)

Some college, no degree

Associate Degree (e.g. AA, AS)

Bachelor's Degree (e.g. BA, BS)

Master's Degree (e.g. MS, MA)

Professional Degree (e.g. RN, MD)

Doctorate (e.g. PhD, EdD)

Name of Last School Attended

License, Certification or Registration Currently Held

Employment History

Company 1

Company Name *

Location *

Dates of Service *

Name of Supervisor *

Position and Duties *

Reason for Leaving *

Company 2

Company Name

Location

Dates of Service

Name of Supervisor

Position and Duties

Reason for Leaving

Company 3

Company Name

Location

Dates of Service

Name of Supervisor

Position and Duties

Reason for Leaving

References

Please give the names of three persons not related to you, whom you have known professionally at least three years. A minimum of one reference must have been an immediate or direct supervisor.

(1) Name of Reference - Direct Supervisor *

Phone Number *

Email Address *

(2) Name of Reference *

Phone Number *

Email Address *

(3) Name of Reference *

Phone Number *

Email Address *

Applicants Statement

Acknowledgement *

I have provided truthful and complete responses to all inquiries in the application and authorize the company to investigate all statements contained in the application. I understand that the discovery of any falsification or omission constitutes a ground for immediate dismissal. If employed, I will abide by the company’s rules and regulations, which I understand are subject to change. I understand that my employment may be terminated with or without cause or notice, at any time, at either my option or that of the company. I understand that no management representative has any authority to enter in to any agreement for continuing employment or for any specific period of time or which is contrary to the forgoing without written approval of the Company. I give the Company permission to contact any or all of my previous employers and references and authorize them to disclose any information the Company may request in the course of its investigation of this application for respect to such disclosures. After a tentative offer of employment has been made, if requested by the Company I agree to take a skills test. I understand that any offer is conditioned upon receipt of satisfactory references and satisfactory completion of such testing.

Date *

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Employment Application

Contact Information

Availability

Education

Employment History

Company 1

Company 2

Company 3

References

Applicants Statement

Grant Award from The Margaret L. Wendt Foundation

This April, Homespace celebrated 30 years of service with a special celebration dinner at The Buffalo History Museum.

Lindsey Carter Named New Executive Director

Contact Us

Homespace

Second Chance

Administrative Office

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