Employment Application Form

Employment History
Start with your present or most recent employment /work history. Please attach your resumé/CV.
Employer #1*
Job title*
Dates employed*
Work phone*
Address*
Street Address Address Line 2 City State ZIP Code
Pay Rate*
Enter your last rate of pay for this employer.
Employer #2*
Job title*
Dates employed*
Work phone*
Address*
Street Address Address Line 2 City State ZIP Code
Pay Rate*
Enter your last rate of pay for this employer.
Employer #3 (If none, enter "N/A")*
Job title
Dates employed
Work phone
Address
Street Address Address Line 2 City State ZIP Code
Pay Rate
Enter your last rate of pay for this employer.
Full Resume/CV/Employment History
Max. file size: 50 MB.

Education
Highest Level of Education Reached*
- High School Diploma or GED
- Some College
- College Degree
- Technical School Certificate
- Other – describe below
Other Education
Please share any relevant experience/information that you feel will reflect the talents and skills you will bring to Stonewall and community members in your interested role.*

Signature Disclaimer
I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application. I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.
Name (please print)*
Date*
MM slash DD slash YYYY
Signature*

Personal Data