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Current Information

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General Information

Are you able to perform all of the duties of the job you have applied for? If no, can you perform them with reasonable accomodation?
Have you ever been convicted of a felony?
Are you an American citizen or do you currently have authorization to work in the U.S?

Education

Indicate highest school year completed

Knowledge, Skills and Abilities

Employment

A. CURRENT OR MOST RECENT EMPLOYMENT (OR EXPLAIN GAP IN EMPLOYMENT)

B. NEXT OR MOST RECENT EMPLOYMENT OR EXPLAIN GAP IN EMPLOYMENT

C. NEXT MOST RECENT EMPLOYMENT OR EXPLAIN GAP IN EMPLOYMENT

Have you had disciplinary action taken against you in the past 12 months?
Have you ever been dismissed or forced to resign from any job?
May we contact any of the above supervisors in reference to your appplication?
  • To the best of my knowledge and belief, the information given truly represents my background and experience. I understand that if I have knowingly or negligently misrepresented, falsified or omitted any information during the application process, or have made any changes to the format or wording of this application form, I may be disqualified for employment or consideration or dismissed from employment with Hunger and Health Coalition. 

  • I authorize my current and former employers to give any information regarding me or my employment, whether or not is on their records. I hereby release them from any damage whatsoever for issuing same.