Employment Application - BangorHousing

First Name:

Middle Name:

Last Name:

Street Address:

Position Sought:

Position Type:

Part-Time

Full-Time

City:

State:

Zip:

Home Phone:

Cell Phone:

Driver’s License State / Number / Expiration Date

Email Address:

Are you a resident of property owned or managed by BangorHousing?

Yes

Are you a participant in BangorHousing’s Housing Choice Voucher (Section 8) program?

Yes

Are you under 18 years of age?

Yes

Are you a United States citizen or are you legally eligible to work in the United States?

Yes

Are you related by blood or marriage to any BangorHousing employee or member of the Board of Commissioners?

Yes

If yes, please list

Have you ever been disciplined, discharged, or asked to resign from a prior position?

Yes

Have you ever resigned from a prior position or been asked to resign in lieu of discharge?

Yes

Have you ever had a professional license or certificate suspended or revoked in any state, or have you ever voluntarily surrendered, temporarily or permanently, a professional license or certificate in any state?

Yes

If you have answered yes to any of the previous three questions, please explain in detail below.

Position Information

How did you hear about this position?

Date available for work?

Education

List each educational institution attended, beginning with most recent.

Name of Educational Institution

Address

Degree Received

Name of Educational Institution

Address

Degree Received

Name of Educational Institution

Address

Degree Received

Name of Educational Institution

Address

Degree Received

Name of Educational Institution

Address

Degree Received

Work Experience

Please list your previous employment history beginning with the most recent. Be sure to account for all periods of time including military service and any period of unemployment.

Company

Position Held

Full-time / Part-time

Date From

Date To

Supervisor Name

Address & Telephone Number

Can we can contact this prior employer for a reference?

Yes

Company

Position Held

Full-time / Part-time

Date From

Date To

Supervisor Name

Address & Telephone Number

Can we can contact this prior employer for a reference?

Yes

Company

Position Held

Full-time / Part-time

Date From

Date To

Supervisor Name

Address & Telephone Number

Can we can contact this prior employer for a reference?

Yes

Company

Position Held

Full-time / Part-time

Date From

Date To

Supervisor Name

Address & Telephone Number

Can we can contact this prior employer for a reference?

Yes

Company

Position Held

Full-time / Part-time

Date From

Date To

Supervisor Name

Address & Telephone Number

Can we can contact this prior employer for a reference?

Yes

Company

Position Held

Full-time / Part-time

Date From

Date To

Supervisor Name

Address & Telephone Number

Can we can contact this prior employer for a reference?

Yes

Company

Position Held

Full-time / Part-time

Date From

Date To

Supervisor Name

Address & Telephone Number

Can we can contact this prior employer for a reference?

Yes

Professional Licenses/Certifications

Type of License/Certification

Date Issued

License No.

Issuing State

Expiration Date

Type of License/Certification

Date Issued

License No.

Issuing State

Expiration Date

Additional Information

List significant experience such as volunteer, military, civic, training or other life experiences not included elsewhere.

References

Please identify at least three individuals, not including relatives, who have personal knowledge of your work abilities and/or personal character.

Name

Address

Position

Telephone Number

Name

Address

Position

Telephone Number

Name

Address

Position

Telephone Number

IT IS THE POLICY OF BANGORHOUSING TO PROVIDE EQUAL EMPLOYMENT OPPORTUNITIES TO ALL CANDIDATES FOR EMPLOYMENT REGARDLESS OF AGE, RACE, SEX, COLOR, RELIGION, ANCESTRY, NATIONAL ORIGIN, PHYSICAL OR MENTAL DISABILITY, SEXUAL ORIENTATION, GENETIC INFORMATION, OR ANY OTHER PROTECTED STATUS.

I certify that all of the information in this application and in any interviews with BangorHousing shall be true and accurate. I understand that any falsification of information or misleading or omitted information shall be grounds to reject this application, or having been employed, shall be immediate grounds for dismissal.

My signature below constitutes authorization for BangorHousing to check my employment and education history, driving records, and/or references. I further authorize those persons, agencies, or entities that BangorHousing contacts in connection with my employment application to fully provide BangorHousing any information on the matters set forth herein without limitation, and I specifically waive any claims for defamation, emotional distress, invasion of privacy, or interference with contractual relations that I might otherwise have against BangorHousing, its agents or officials, or against any provider of such information.

I understand that this application is not intended to be a contract for employment. In consideration of my employment at BangorHousing, should I be selected, I agree to conform to its rules and regulations. I understand that I would be an “employee at will” and that my employment and compensation can be terminated, with or without cause, with or without notice, at any time at the option of either the company or myself. I understand that no employee or representative of BangorHousing has authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing. Any such modification or agreement to the contrary must be in writing and signed by the Executive Director.

Date

Signature(Required)