Job Application

Thank you for your interest in working at Chum. Please complete the application below for consideration in joining our team!

First Name

Middle Initial

Last Name

Email Address

Phone Number

Street Address

City

State

ZIP

Date of Application

mm/dd/yyyy

What Position(s) Are You Applying For?

Stabilization ManagerFamily CoachShelter Support StaffSt. Francis Support StaffChum Summer Internship - Street Homelessness ResponseChum Yearlong Internship - Street Homelessness Response

Please read carefully and complete the remainder of the application.

An Equal Opportunity Employer
We are an equal opportunity employer, and we do not and will not discriminate on the basis of race, religion, national origin, sex, age, handicap, marital status, or status as a disabled veteran. Information provided on this application will not be used for any discriminatory purpose.

Employment Record
Starting with present or most recent, list all previous employers. Include self-employment and summer and part-time jobs. If more space is required, please continue on a separate sheet. You may attach a resume, but complete this application as well.

Employer 1:

Last or Present Company

Type of Business

Street Address

Phone Number of Business

City

State

ZIP

Supervisor's Name

Supervisor's Phone Number

Job Title

Dates Worked

Job Duties

Reason For Leaving

Employer 2

Last or Present Company

Type of Business

Street Address

Phone Number of Business

City

State

ZIP

Supervisor's Name

Supervisor's Phone Number

Job Title

Dates Worked

Job Duties

Reason For Leaving

Education History

Please fill out any fields applicable to you.

High School Name

High School Location

City, State

Dates Attended

Graduated?

YesNo

Technical/ Trade School Name

Location

City, State

Dates Attended

Graduated?

YesNo

Degree Received

College Name

Location

City, State

Dates Attended

Graduated?

YesNo

Degree Received

Other Relevant Experience, Training or Education:

Outside Activities

(Exclude outside activities indicating race, color, religion, sex, national origin, age, or handicap.)

Professional Memberships, Certificates

Past and present civic or cultural activities - include any offices held

Principal Hobbies

Professional/ Work References

Reference 1

Name

Title

Address

Street, City, State, ZIP

Phone Number

123-456-7890

Occupation

Reference 2

Name

Title

Address

Street, City, State, ZIP

Phone Number

123-456-7890

Occupation

Reference 3

Name

Title

Address

Street, City, State, ZIP

Phone Number

123-456-7890

Occupation

May we contact your present employer?

YesNo

Date Available to Start

mm/dd/yyyy

Explain why you would be a great candidate for this position:

Upload Your Resume

I hereby certify that the answers and other information on this application are true and correct and that I understand any misrepresentation or omission of facts on my part will be justification for separation from the company’s service, if employed. I understand that my employment may be contingent upon receipt of an alien registration number, verification of birth, and any other pertinent information bearing upon my employment, and that my continued employment depends upon the will of the company or myself. If you agree, enter today's date below and hit submit to sign.

Date

mm/dd/yyyy