Catholic Charities
Employment Application Form

Date:
Last Name, First Name, Middle Name:
Mailing Address:
Telephone(s):
E-mail(s):

May we contact you at your current employment (yes/no)?

GENERAL INFORMATION –

Position applied for:
Available to work (circle): 
Full-time, Part-time, Temporary, Days, Nights, Weekends
Days and hours available:
When would you be able to begin work:
If you are under age 18, can you provide required proof of documentation (yes/no)?
Are you prevented from being lawfully employed in the U.S. due to Visa or immigration status (yes/no)?  (Proof of citizenship or immigration status will be required upon employment.)
Have you ever worked or volunteered for the Roman Catholic Church or a Catholic affiliated organization (yes/no)?  If yes, where?
How did you learn about us? 
Are you related to anyone in our employ? If yes, please provide name:

EDUCATION –

(List degrees obtained)
High School (Name and Address):
College (Name and Address):
Other (Name and Address):

EMPLOYMENT HISTORY –

Please list your present and past work experience for the last 10 years, beginning with your current job. You may include volunteer activities/positions.  If additional space is necessary, attach a separate sheet of paper, using the format on this page.

Name of Employer #1:
Address:
Telephone:
Position Supervisor:
Employment Dates/Rate of Pay:
Description of Duties:
If current employer, OK to contact (yes/no)?
Reason for Leaving:

Name of Employer #2:
Address:
Telephone:
Position Supervisor:
Employment Dates/Rate of Pay:
Description of Duties:
Reason for Leaving:

Name of Employer #3:
Address:
Telephone:
Position Supervisor:
Employment Dates/Rate of Pay:
Description of Duties:
Reason for Leaving:

Name of Employer #4:
Address:
Telephone:
Position Supervisor:
Employment Dates/Rate of Pay:
Description of Duties:
Reason for Leaving:

Name of Employer #5:
Address:
Telephone:
Position Supervisor:
Employment Dates/Rate of Pay:
Description of Duties:
Reason for Leaving:

Why do you want to be considered for employment here?

Do you have a valid driver's license (yes/no)? If yes, please list state issued & license number:

Please summarize any specialized job-related skills and qualifications acquired from employment or other experience, including volunteer activity:

Are you a veteran of the United States military services? If yes, please state branch:

Please list any job-related professional trade, business or civic activities, organizations and/or associations (you may omit those which indicate race, color, national origin, ancestry, sex or age). Also list any job-related skills, licenses, certificates, special study or research work.

Have you ever been convicted of a crime (yes/no)? 
If yes, please explain:

Have you ever been reprimanded, suspended, disciplined, demoted or otherwise subject to negative job action by any former or current employer, at any time (yes/no)?
If yes, please explain:

Has your employment activity been the subject of any lawsuit or claim by any third party, including but not limited to any client, patient or customer, against any former or current employer?  (yes/no)  
If yes, please explain:

Work at Catholic Charities often involves confidential or sensitive information about the people we serve.  Catholic Charities receives government and donated private funds to operate its programs.  Catholic Charities is identified by its name and mission with the teachings and faith of the Roman Catholic Church.  Given all of this, are there other things about you, that you believe Catholic Charities should know in making its decision of whether or not to hire you?


INFORMATION CERTIFICATION: I hereby certify that the information contained in this application form is true and correct to the best of my knowledge and I agree to have any of the statements checked by Catholic Charities unless I have indicated to the contrary. I authorize all previous employers, supervisors, and all persons with and for whom I have worked, to give Catholic Charities representatives any and all information regarding me and my previous employment. I release Catholic Charities and all previous employers, supervisors, and all persons with and for whom I have worked, from any liability for any damages that may result from furnishing information to Catholic Charities. I understand that any misrepresentation, falsification or material omission of information on this application may result in my failure to receive an offer, or if I am hired, my dismissal from employment. In consideration of my employment I agree to conform to the rules and standards of the employer, including those described in the Catholic Charities Employee Handbook and Catholic Charities Code of Ethics.  I further agree and understand that my employment is at-will and can be terminated at any time with or without cause and with or without notice, either at my option or at the option of the employer. I further understand that no agreement which is contrary to this at-will employment relationship shall be effective unless it is contained in a specific, express, written contract which is signed by the agency Executive Director.  I also understand that all offers of employment are conditioned on providing satisfactory proof of my identity and legal authority to work in the United States.


_________________________________________________________________
Signature of Applicant 					Date



PRINT FORM and fax to:   (503) 231-4327

Or
 
PRINT FORM and mail (or deliver) to:  2740 SE Powell Boulevard, Portland OR 97202.