Employment Application - Suffolk Redevelopment and Housing Authority

Employment Application
Optional Data Collected For Statistical Purposes

Phone: 757-539-2100 | Fax: 757-539-5184
530 East Pinner St. | Suffolk, VA 23434
SuffolkrHA.org
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Position Applied For:

Date Available:

Salary Desired:

Last Name:*

First Name:*

Middle Name:

Street:*

City:*

State:*

Zip Code:*

Social Security Number:*

Email Address:*

Email Confirmation:*

Home Phone:

Cell Phone:

If under 18, Date of Birth:

Do you have the legal right to work in the US?

Do you have any relatives working for the Authority?

Yes No

If yes, who works for the Authority:

Relationship of Authority Employee:

Do you have any relatives on the Board of Commissioners?

Yes No

If yes, whom is on the Board of Commissioners?

Relationship of Board Member:

Have you ever been employed by the Authority?

If yes, Start Date:

End Date:

Position:

All positions require a valid driver's license and eligibility for coverage under the Authority's automobile insurance.

Do you have a valid driver's license?

Have you received any traffic violations in the past 2 years?

If yes, please explain traffic violations:

Have you ever been in the Armed Services?

If yes, Branch of Service:

Discharge Date:

Have you ever been discharged or forced to resign from a position?

Yes No

If yes, explain discharge or resignation:

Education

High School Diploma or GED:

High School or GED Address:

If no, highest grade completed:

College 1 Name:

College 1 Address:

College 1 Major and Type of Degree:

Did you graduate College 1?

College 2 Name:

College 2 Address:

College 2 Major and Type of Degree:

Did you graduate College 2?

Special Courses: (Please include School Name, Types of Courses, Credits.)

Certifications:

Work History

Begin with most current/recent employer and/or military service.

Past Employer 1

Company Name:

Company Address:

Company Phone:

Name/Title of Supervisor:

Start Date:

End Date:

Job Title:

Ending Salary:

Job Duties:

Reason for Leaving:

Add Another

State reason and length of inactivity between employers:

May we contact your present employer for a work reference?

To assist us in verifying your prior employment, have you ever worked under another name?

If yes, list name:

References

Provide name and contact information for three (3) professional references other than past employers.

Reference 1

Name:

Address:

Phone:

Reference 2

Name:

Address:

Phone:

Reference 3

Name:

Address:

Phone:

Upload File

Optional – Attach your PDF resume here (max file size 2mb)

I hereby affirm that the information given in this application is true and accurate to the best of my knowledge and belief. I understand that any false statement contained herein will disqualify me for employment consideration with the Suffolk Redevelopment and Housing Authority.

I hereby authorize all my previous employers and persons listed as personal references to furnish any information concerning my personal character, work habits or employment record, and I release all such persons from liability for damages incurred as a result of furnishing such information.

Suffolk Redevelopment and Housing Authority is an equal opportunity employer. Our policy is to consider all applicants for employment based on their qualifications and our current job vacancies. Applicants are considered without regard to race, color, religion, national origin, age or disability.

Signature

Signature of Applicant:*

Date of Signature of Applicant:*

Authorization to Release Personnel Information

I am seeking employment with Suffolk Redevelopment and Housing Authority and hereby authorize my past and present employers and past and present educational institutions to release information regarding my employment or educational transcript record with same.

Further, I understand that my past and present employers and past and present educational institutions are not responsible in any way for the uses made of this information by Suffolk Redevelopment and Housing Authority.

I hereby also release from liability the Suffolk Redevelopment and Housing Authority and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.

Should I be hired prior to the Suffolk Redevelopment and Housing Authority's completion of verification of employment work history, performance on the job, or education, any unsatisfactory reports, false information or omissions given by me may be considered grounds for my dismissal.

I also agree that a photocopy of this agreement shall be as valid as the original.

Signature of Applicant Authorizing Release of Information:*

Date of Signature of Applicant Authorizing Release of Information:*

*Required Fields