APPLICANT INSTRUCTIONS
Thank you for your interest in People Helping People of North Carolina, LLC. We strive to obtain the most qualified individuals available to serve our consumers. Even though every applicant cannot be hired, every application, if completed properly will be carefully considered. It is very important that you carefully read the following instructions and complete the application in its entirety to be considered for employment. 1. Complete the application online. You can then print your application to submit by mail or to hand deliver it to the PHP office. If you prefer, you may E-mail your application to PHP by selecting the “E-mail Application” button located at the bottom of the form.
(It is recommended that you print a copy for your records before submitting your application to PHP)
2. Give complete information on your education and work history. “See my Resume” is not an acceptable answer. You are welcome to attach Letters of Recommendations, resumes and/or related materials to you application. 3. If you worked in more than one position with an employer, please list the duties for each position held. If a position was part-time, please also add the weekly hours worked as correctly as possible. 4. Please list all of your diplomas and/or degrees in the Education History section. PROOF OF DIPLOMA OR GED IS MANDATORY. IF THE POSITION YOU ARE APPLYING FOR REQUIRES A DEGREE, YOU MUST SUBMIT A COPY OF YOUR COLLEGE OR UNIVERSITY TRANSCRIPT. 5. Please check your application to be sure it is complete and accurate. applications will not be considered. Incomplete
To help ensure all employees are fit to perform their assigned duties, all People Helping People employees are subject to a Criminal Records check and random Drug Testing. Applicants with a positive Drug Test will not be considered for employment. Employees with a positive Drug Test will face immediate dismissal. After you have submitted your completed application please allow us time to verify all of your information. Our Personnel Coordinator will contact you when a position that matches your experience comes available. If there are no positions available, we will keep your application on file for 90 days. We do ask that you refrain from calling the office to check on the status of your application. We work diligently to process all of the applications that we receive. We will contact you promptly as soon as we have a position available in which you would be a good candidate for. Thank you in advance for your cooperation and we look forward to working with you.
www.PHPofNC.org
4550 Country Club Road Winston-Salem, NC 27104
Effective: 4/1/2009
APPLICATION FOR EMPLOYMENT
PERSONAL INFORMATION
Date of Application Last Name Position Applying for First Name YES NO Cell Phone ( ) Apartment # State Zip Is PHP authorized to leave messages with this contact at this number? Relationship
Date of Birth Gender
Middle Name
(If yes, please print below)
Are you known by any other name to Past Employers or References? Home Phone ( ) Street Address City Contact person in case of Emergency Phone ( ) Work Phone ( )
YES
Ethenticity
NO
GENERAL INFORMATION
Have you ever been employed with People Helping People of North Carolina either Full-time or Part-time? YES NO
(If yes, please explain)
Have you applied for employment with People Helping People of North Carolina in the past year? YES NO
(If yes, list the approximate date)
Do you have a valid North Carolina driver’s license?
Drivers License #
YES
NO
(If yes, complete the following)
Expiration date
What will be your primary means of transportation to and from work?
(If OTHER, please explain)
CAR
OTHER
Have you ever been convicted of a crime?
YES
NO
(If yes, please explain)
SPECIAL SKILLS
Typing or Word Processing (WPM) Other (Please explain) Computer Skills (Software) Foreign Languages
www.PHPofNC.org
4550 Country Club Road Winston-Salem, NC 27104
Effective: 4/1/2009
EDUCATIONAL BACKGROUND
High School Name Address Dates Attended Major Semester Hours Did you graduate? YES NO
Technical School Name Address Dates Attended Major
Did you graduate? YES NO
Semester Hours
College/University Address Dates Attended Major
Did you graduate? YES NO
Degree Earned?
Graduate School Address Currently enrolled? YES NO Year earned?
Did you graduate? YES NO
Degree earned?
MILITARY SERVICE
Have you ever been in the Armed Forces? Which branch? Honorable Discharge? YES NO
(If no, please explain)
YES
NO
(If yes, please continue below)
Date of discharge?
REFERENCES
Name Name Name Occupation Occupation Occupation Phone ( ) Phone ( ) Phone ( )
www.PHPofNC.org
4550 Country Club Road Winston-Salem, NC 27104
Effective: 4/1/2009
EMPLOYMENT HISTORY (List current or most recent position first)
Employer Address Dates Employed Did you supervise others? YES (If yes, how many?) Starting Salary / Ending Salary List job duties in order of importance Supervisor’s Name NO Reason for leaving
Position Held
Type of Agency (Private, Government, Etc.)
Supervisors Phone ( ) FULL TIME PART TIME How many hours per week?
Employer Address Dates Employed Did you supervise others? YES (If yes, how many?) Starting Salary / Ending Salary List job duties in order of importance
Type of Agency (Private, Government, Etc.)
Position Held
Supervisor’s Name NO Reason for leaving
Supervisors Phone ( ) FULL TIME PART TIME How many hours per week?
Employer Address Dates Employed Did you supervise others? YES (If yes, how many?) Starting Salary / Ending Salary List job duties in order of importance
Type of Agency (Private, Government, Etc.)
Position Held
Supervisor’s Name NO Reason for leaving
Supervisors Phone ( ) FULL TIME PART TIME How many hours per week?
www.PHPofNC.org
4550 Country Club Road Winston-Salem, NC 27104
Effective: 4/1/2009
EMPLOYMENT HISTORY (Continued)
Employer Address Dates Employed Did you supervise others? YES (If yes, how many?) Starting Salary / Ending Salary List job duties in order of importance Supervisor’s Name NO Reason for leaving Supervisors Phone ( ) FULL TIME PART TIME How many hours per week? Type of Agency (Private, Government, Etc.) Position Held
Employer Address Dates Employed Did you supervise others? YES (If yes, how many?) Starting Salary / Ending Salary List job duties in order of importance
Type of Agency (Private, Government, Etc.)
Position Held
Supervisor’s Name NO Reason for leaving
Supervisors Phone ( ) FULL TIME PART TIME How many hours per week?
Employer Address Dates Employed Did you supervise others? YES (If yes, how many?) Starting Salary / Ending Salary List job duties in order of importance
Type of Agency (Private, Government, Etc.)
Position Held
Supervisor’s Name NO Reason for leaving
Supervisors Phone ( ) FULL TIME PART TIME How many hours per week?
Applicant Initials __________ www.PHPofNC.org 4550 Country Club Road Winston-Salem, NC 27104 Effective: 4/1/2009
WORK AVAILABILITY
When will you be available to start work?
Please fill in your hours of availability. Be as specific as possible Sunday Monday Tuesday Wednesday Start time End time
Thursday
Friday
Saturday
List any special requirements you have involving work schedules (Continue on a separate piece of paper if needed)
Please indicate the Counties that you are willing to serve. (List all that apply) FORSYTH STOKES DAVIE ROCKINGHAM OTHER ___________________________
Please read the following statements carefully and initial if you agree.
In submitting this application, I understand that: __________ 1. The submission of this application is not a promise (implied or otherwise) of an interview or employment. __________ 2. That a pre-employment interview is not a promise (implied or otherwise) of employment. __________ 3. I also understand that a final offer of employment will be based on results of a medical examination, background check, motor vehicle check, and possible drug screening. In addition I must provide evidence of my education, my automobile insurance, and my valid driver’s license. __________ 4. Any misrepresentation of facts in this application or in connection with any medical examination will be just cause for rejection of my application. __________ 5. I understand that if hired I will be paid minimum wage while attending New Hire Orientation and/or Agency Trainings. __________ 6. I understand that if hired I will be utilizing my personal vehicle for People Helping People and I am responsible for maintaining liability, comprehensive and collision insurance on my automobile. __________ 7. I also understand that if hired my hourly wage includes mileage. __________ 8. I understand that People Helping People does not guarantee a specific work schedule or job assignment. __________ 9. It is recommended, but not mandatory, that all PHP employees sign up for Direct Deposit. __________ 10. As a condition of employment, People Helping People requires that it’s employees: A. Maintain a valid driver’s license. B. Maintain required trainings and certifications. C. Communicate any changes and/or incidents concerning the consumer with the management staff. D. Communicate any changes with my driver’s license or Criminal Record. st __________ 11. I understand that as a courtesy People Helping People offers free OSHA, NCI, CPR/1 aid certification. I understand that I have the option to take these trainings elsewhere at my own expense. __________ 12. I understand if I utilize PrimeCare for my physical and TB Skin Test, I am authorizing for payment to be deducted from my pay check if not paid at time of service.
www.PHPofNC.org
4550 Country Club Road Winston-Salem, NC 27104
Effective: 4/1/2009
AGREEMENT TO APPLICATION SUBMITTAL
I agree that: Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of People Helping People of North Carolina, LLC. Or otherwise to change in any respect the employmentat-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the CEO/Designated Staff of the Company. Both the undersigned and People Helping People of North Carolina, LLC. may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the People Helping People of North Carolina, LLC. may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits. I authorize investigation of all statements contained in this application; I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without previous notice. I hereby give People Helping People of North Carolina, LLC. permission to contact the military, schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract. I also understand that (1) People Helping People of North Carolina, LLC. has a drug and alcohol policy that provides for testing as determined by the policies of this agency (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations. I understand that, in connection with the routine processing of your employment application, People Helping People of North Carolina, LLC. may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, People Helping People of North Carolina, LLC. will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act. I further understand that my employment with People Helping People of North Carolina, LLC. shall be probationary for a period of ninety (90) days, and further that at any time during probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.
Signature of applicant ______________________________________________ Date ________________________
People Helping People of North Carolina, LLC. is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications
www.PHPofNC.org
4550 Country Club Road Winston-Salem, NC 27104
Effective: 4/1/2009
CONSUMER REPORT RELEASE
In connection with my application for: Employment (including contact for services) Volunteer or Internship I hereby authorize without reservation, any party or agency contacted by this employer to furnish the abovementioned information. I understand I have the right to make a request of the Consumer Reporting Agency, upon proper identification and the payment of any authorized fees, the information in its files on me at the time of my request. I further authorize ongoing procurement of the above-mentioned reports at any time during my employment (or contract). (Please PRINT the following information) First Name List Former Names or Alias’s Drivers License State Professional License Street Address City Years at this Address? Previous Address (If less than 3 years) City Years at this Address? State Zip Code State Zip Code Drivers License Number License State Social Security Number License Number Middle Initial Last Name Maiden Name
Signature of applicant ______________________________________________ Date ________________________
www.PHPofNC.org
4550 Country Club Road Winston-Salem, NC 27104
Effective: 4/1/2009
What you will need for Employment
The following is what you will need for employment. Please ensure that you have access to all of the following prior to submitting your application for employment.
_____ Completed Application for Employment _____ Completed Consumer Report Release Form _____ First Advantage / TIS Criminal Records Check (Agency will provide) _____ First Advantage / TIS MVR Report (Agency will provide) _____ Valid Drivers License _____ Proof of Current Automobile Insurance _____ Valid Social Security Card or Birth Certificate _____ Completed I-9 Form _____ Proof of Education _____ High School Diploma or GED _____ Highest Level of Education (Diploma & Transcript) _____ Current Employment Physical (Pre-employment) _____ Current TB Vaccination (Pre-employment) _____ Two References Verifying Previous Employment _____ Current Certification of CPR / First Aid, NCI, etc. (Agency can provide) _____ A VOIDED check for Direct Deposit.
www.PHPofNC.org
4550 Country Club Road Winston-Salem, NC 27104
Effective: 4/1/2009