Application for Employment
Second Haven Services for Youth
P.O. Box 329
Mount Pocono, PA 18344
(866)343-5509 ext. 701
This application for employment shall be considered for a period of time not to exceed six months.
Last Name
*
First Name
*
Middle Name
Maiden Name
Email Address
*
Address
*
City
*
State
*
Zip Code
*
Home Phone Number
*
Cell Phone Number
Social Security
*
Position Applied For
*
Date of Application
*
How did you hear about us?
*
Advertisement
Walk-In
Second Haven
Relative/Friend
Employment Fair
Other
Internet
Are you at least 21 years of age?
*
Yes
No
Have you ever filed an application with us before?
*
Yes
No
If so when?
Have you ever been employed with us before?
*
Yes
No
If so when?
Are you currently employed?
*
Yes
No
May we contact your present employer?
*
Yes
No
Are you prevented from lawfully becoming employed in this country due to immigration status or a Visa?
*
Yes
No
On what date are you available to start work?
*
Employment desired?
*
Full Time
Part Time
Summer Work
Temporary
Are you available for?
*
Shift Work
Weekend Work
Are you currently on layoff status and subject to recall?
*
Yes
No
Have you ever been convicted, pleaded guilty, or No Contest to a felony or a misdemeanor?
*
Yes
No
If yes, please explain:
Education
*
High School
Undergraduate
Graduate Professional
Other
Military
Name and Address of School
*
Course of Study
Number of Years Completed
Degree or Diploma
Year Completed
Do you have any other experience, training, qualifications, or skills which you feel should be brought to our attention, in the case that they make you especially suited for working with us? (Specifically list software applications):
*
State any additional information you feel may be helpful to us in considering your application:
*
List professional trade, business, or civic activities, offices held, volunteer work, as well as pertinent extracurricular activities:
*
Employment Experience (Please list present employer’s first and military service assignments)
Employer
Date Employed From
Date Employed To
Address
Job Title
Work Performed
Salary Starting and Final
Supervisor
Telephone Number
Reason for Leaving
Employer
Date Employed From
Date Employed To
Address
Job Title
Work Performed
Starting Salary and Final Salary
Supervisor
Telephone
Reason for Leaving
