Employment Application Step 2

Step 1 of 5

Name*
First Last
Date*
MM slash DD slash YYYY
Position Appling For*
Salary Expectation*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Enter Email Confirm Email
Hidden
HIDDEN: Social Security Number
Are you legally eligible for employment in this country?*
- Yes
- No
Note: If you are hired, you will be required to produce documents about your eligibility for employment in order to complete an I-9 Form.

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Educational Background
Education
Education Institution Name City Dates Attended Degree Earned

Tell us about your High School, College, Graduate, or Other schooling.
Computer Skills
Computer Skills
Software Program Skill Level (Basic/Proficient/Expert)

Please list all computer software programs you are familiar with and state your skill level.
Can You Type?
- Yes
- No
How Many Words Per Minute?

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References
References
Name Phone Relationship Years Known

If possible, list two business references and one personal reference who are not related to you and who were not your previous supervisors. Otherwise, list three personal references not related to you.
I understand that this application may be withdrawn or my employment may be terminated if I have made any misrepresentations on this form. I authorize Attack Poverty to contact all references to seek job-related information about me, and I release Attack Poverty and all other persons and companies from liability for furnishing or obtaining such information.
Signature
Date of Signature
MM slash DD slash YYYY

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Authorization and Release of Information Form
I authorize Attack Poverty and its agents to contact any person or employers listed on my employment application to confirm information supplied by me and/or to obtain other material information about my employment. I authorize all persons and employers to release any information about my qualifications. I also release any person or employer, which provides information from any and all liability for providing that information, excepting only the communication of knowingly false information.
Signature
Name
First Last
Date
MM slash DD slash YYYY
Authorization for Background Check
It is my understanding that Attack Poverty and its authorized representatives will conduct a comprehensive public record search of my personal history.
I hereby authorize an officer or employee of Attack Poverty and its authorized representatives bearing this release or a copy of this release, within one year of its date, to obtain information in your files pertaining to my employment, education, credit and personal history, including but not limited to, academic achievement, personal history, performance reports, criminal public record searches, reasons for termination, all records contained in any City, County, State, Federal or any political subdivision thereof, including but not limited to, Criminal History information, Uniform Commercial Code, State Motor Vehicle Records, Vital Statistics, Incorporation’s, Certifications or licenses, Military Records or any other information.
I hereby release you, as custodian of, both individually and collectively, as an agency of the federal government, state, city, county or any political subdivision thereof, or university, or any other educational institution, credit bureau, lending institution, consumer reporting agency holding records considered confidential to me, from any and all liability for damages of whatever kind, which may at any time result to me, my heirs, family or associates because of compliance with this authorization and request to release information or any attempt to comply with it. I hereby release any law enforcement agency from any and all liability resulting from such disclosure. I hereby release Attack Poverty and its authorized representatives, and any governmental or private agency or other repository of criminal records, social security or driving records, from any and all liability for damage of whatever kind, because of compliance with this authorization.
- I Authroize Attack Poverty to run a background check using the information I have provided here.
Signature
Driver’s License Number
State
Full Name
Prefix First Last Suffix
Previous Address
Street Address Address Line 2 City State ZIP Code
Maiden Name
Last
Hidden
HIDDEN: Date of Birth
MM slash DD slash YYYY
Hidden
HIDDEN: City, State of Birth
Phone
This field is for validation purposes and should be left unchanged.

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Attack Poverty will be serving those impacted by Hurricane Ida by seeking to support those who have been and will continue to be on the ground and part of the community.

Step 1 of 5

Employment History: Current or Last Employer

Next Previous Employer

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Educational Background

Computer Skills

References

Authorization and Release of Information Form

Authorization for Background Check

Education Institution	Name	City	Dates Attended	Degree Earned

Software Program	Skill Level (Basic/Proficient/Expert)

Name	Phone	Relationship	Years Known