Voluntary Affirmative Action Information

All candidates for employment by Heifer International will be considered without regard to race, age, religion, disability or gender. Date:

________ ________

Position applied for:

Referral Source: ________

Advertisement
If so, which publication __________

Employee

School

If so, which employee _____________If so, which school _____________

Relative !al"#in Employment A$ency %olunteer Internet &ther

Date of 'irth: ________

(ale )emale

Application for Employment

*eifer International considers applicants for all positions without re$ard to race, a$e, reli$ion, color, creed, se+, or disability,

Position Applied )or :________ Date of Application :________ -ame ./ast0 Address District
________

.)irst0 1ity

________

.(I0

________

________

________

________

2one

________

1ountry :

________

*ome Phone:

________ .include area code0

!or" Phone:

________________ .include area code0

E#mail address:

________

(obile Phone:

________________ .include area code0

Are you currently employed ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, -o (ay we contact you at your current 4ob to arran$e an interview ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

3es 3es

-o
(ay we contact your present employer for a reference ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

3es 3es

-o

*ave you ever filled out an application with us before ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

-o
If yes, $ive date _________________ *ave you ever been employed with us before ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, -o If yes, $ive date _________________

3es 3es

Are you prevented from lawfully becomin$ employed in this country ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

-o
&n what date would you be available for wor" __________________ Are you see"in$: .1hec" all that apply0

)ull 5ime Part 5ime 5emporary

Are you currently on 6lay#off7 status and sub4ect to recall ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 3es

-o
2

1an you travel if the 4ob re8uires it ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 3es

-o

*ave you been convicted of a felony within the last 9 years ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 3es -o .1onviction will not necessarily dis8ualify you0

Educational 'ac"$round
School and /ocation 3ear of :raduation De$ree &btained

Employment and %olunteer Information /ist all prior wor" e+perience, includin$ be$innin$ with your most recent employment, .Include all wor" e+perience even if you do not believe that e+perience to be related to the position or positions for which you are applyin$,0 3ou may include volunteer or unpaid wor" as part of your history; however, you should include the number of hours per wee" which you performed these duties, If you do not have enou$h space to list all your wor" e+perience, use a separate sheet for continuation, Even if you include a resume you must still complete the entire application,

1.

1urrent or most recent employer:

Employment dates: )rom __________ _____

3ear (onth

'usiness phone number: 1omplete mailin$ address 1ity : 2one : Supervisor<s -ame: 3our 4ob title: 3our 4ob duties .be specific0 : Reason for leavin$: District :

5o _________

(onth

______

3ear

Avera$e hours wor"ed per wee" ____ _____ Salary: .per month0 Rs,__________
/owest

___
*i$hest

2.

1urrent or most recent employer:

Employment dates: )rom _____ ____

(onth

'usiness phone number: 1omplete mailin$ address 1ity : 2one : Supervisor<s -ame: District :

_______ ________

3ear

5o ______
(onth

3ear

Avera$e hours wor"ed per wee" ______ _____ Salary: .per month0

-ame under which employed 3our 4ob title 3our 4ob duties .be specific0: Reason for leavin$ : 'etter opportunity,

Rs,__________ Rs,__
/owest

*i$hest

___

1urrent or most recent employer:

Employment dates: )rom _____ 5o _____

(onth

'usiness phone number : 1omplete mailin$ address 1ity 2one Supervisor<s -ame : -ame under which employed : 3our 4ob title 3our 4ob duties .be specific0: Reason for leavin$: District

__________ _

3ear

________
(onth

3ear

Avera$e hours wor"ed per wee" _____ _________ Salary: .per month0 Rs,__ _____
/owest

___________
*i$hest

!.

1urrent or most recent employer:

Employment dates: )rom _________ 5o _____

(onth

'usiness phone number 1omplete mailin$ address 1ity 2one Supervisor<s -ame: -ame under which employed: 3our 4ob title: 3our 4ob duties .be specific0: Reason for leavin$: District

_______

3ear

_________
(onth 3ear

Avera$e hours wor"ed per wee" _____ _________ Salary: .per month0 Rs,__________ _____
/owest *i$hest

References Please list three .=0 persons not related to you, who have "nowled$e of your wor" 8ualifications and can serve as a reference for you,
-ame >, ?, =, Address 5elephone

Special S"ills Please indicate any forei$n lan$ua$e s"ills: Please indicate 'e$inner, Intermediate, Advanced:

/an$ua$e

Read

!rite

)luency @ Spea"

/ist any other s"ills relative to the 4ob.s0 for which you are applyin$:

Applicant<s 1onsent I certify that the answers $iven herein are true and complete to the best of my "nowled$e, I authoriAe investi$ation of all statements contained in this application for employment as may be necessary in arrivin$ at an employment decision, I understand that *eifer International will ma"e a thorou$h review of my entire wor" history, verify all data $iven in my application, related papers or oral interviews as well as conduct a criminal bac"$round chec", I authoriAe such investi$ation and the $ivin$ and receivin$ of any information re8uested by *eifer International, I release from liability any person $ivin$ or receivin$ such information, I understand that falsification of data $iven or other dero$atory information discovered as a result of this investi$ation may prevent my bein$ hired, or if hired, may sub4ect me to immediate dismissal, I further understand that this is an application for employment and that no employment contract is bein$ created, I understand that if chosen for an interview I must provide a copy of my 1itiAenship for the purposes of a criminal bac"$round chec", I have read and understand the above,

-ame _______________________________________ Date_______________________