Employment Application

Full Name *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Phone *

Is the phone number above your: *ResidenceCellOther

Email Address *

Does anyone help you with communication (phone, email, etc.)? *YesNo

If yes, please provide their Relationship to You, Name, Phone, and Email if available. *

Do you have a history of violent or abusive behavior? *YesNo

If yes, please explain *

Emergency Contact Name *

Emergency Contact Relation to You *

Emergency Contact Phone *

Emergency Contact Email *

How many hours per week are you available? *

What kind of experience do you have for the position you are applying for? Provide dates, employer, details of experience: *

Please select the date you can start? *

Are you willing/able to work weekends & holidays? *YesNo

Are you authorized to work in the United States? *YesNo

Have you ever worked/volunteered for this company before? *YesNo

Are you currently enrolled or have you completed any of the DISH Foundation’s Vocational Training Program (VTP) courses? *YesNo

If yes, which one(s)? *

Have you ever participated in any other job training, vocational training, or culinary training? *YesNo

If yes, please provide the details below. *

If yes, please provide dates and position: *

What are some of the biggest challenges you face when seeking employment? *

Have you ever been convicted of a felony? *YesNo

If yes, please explain: *

Education

Did you graduate high school? *YesNo

If yes, Name of School and the Year you Graduated: *

Did you attend any other education or job skills programs after high school? *YesNoE.g. Technical College, Community College, University

If yes, Name of School, Dates Attended and Area of Study *

Did you earn a degree? *YesNo

If yes, what degree? *

Did you attend any other education or job skills programs not listed? *YesNo

If yes, Name of School, Dates Attended and Area of Study *

Did you earn a degree? *YesNo

If yes, what degree? *

Did you attend any other education or job skills programs not listed? *YesNo

If yes, Name of School, Dates Attended and Area of Study *

Did you earn a degree? *YesNo

If yes, what degree? *

Did you attend any other education or job skills programs not listed? *YesNo

If yes, Name of School, Dates Attended and Area of Study *

Did you earn a degree? *YesNo

If yes, what degree? *

References

Please provide information for three non-related references.

Reference #1

Reference #1 Name *

Reference #1 Company

Reference #1 Email Address *

Reference #1 Phone *

Reference #1 relationship to you: *

Reference #2

Reference #2 Name *

Reference #2 Company

Reference #2 Email Address *

Reference #2 Phone *

Reference #2 relationship to you: *

Reference #3

Reference #3 Name *

Reference #3 Company

Reference #3 Email Address *

Reference #3 Phone *

Reference #3 relationship to you: *

Experience/Work History

Most Recent First

Date(s) Worked *

Company *

Location *

Supervisor *

Phone *

Title *

Job Duties *

Reason for Leaving *

May we contact them? *

YesNo

Date(s) Worked *

Company *

Location *

Supervisor *

Phone *

Title *

Job Duties *

Reason for Leaving *

May we contact them? *

YesNo

Date(s) Worked *

Company *

Location *

Supervisor *

Phone *

Title *

Job Duties *

Reason for Leaving *

May we contact them? *

YesNo

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. *

Yes

By checking ACCEPT below, I agree that this represents my electronic signature. *ACCEPT

Your Printed Name *

Would you like to upload your resume now? *YesNo

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