OAR of Fairfax County: Employment Application

Employment Application

Personal Data

Last Name: *

First Name: *

M.I.:

Date of Application: * (mm-dd-YYYY)

Street Address: *

City: *

State: *

Zip: *

Home Number: *

Cell Number:

Day Phone: *

Email Address: *

Are you legally eligible to work in the U.S.? Yes No

If you are not a U.S. citizen, are there restrictions on your eligibility for employment? Yes No

Have you ever worked for this company? Yes No

If so, when?

Position Iinterests

Desired Position:

Desired Salary:

Date Available: (mm-dd-YYYY)

Work Desired: Full Time Part Time

Education

High School:

Name of School:

City/State:

Graduated: Yes No

College/University:

Name of School:

City/State:

Dates Attended:

Major:

Minor:

Graduated: Yes No

College/University:

Name of School:

City/State:

Dates Attended:

Major:

Minor:

Graduated: Yes No

College/University:

Name of School:

City/State:

Dates Attended:

Major:

Minor:

Graduated: Yes No

Other Education/Training:

Name of School:

City/State:

Dates Attended:

Field of Study:

Graduated: Yes No

Special Qualifications

Please include any other special qualifications/skills/awards/honors that you feel is significant to the desired position:

Criminal Background

Have you ever been convicted of a crime?: Yes No

If so, please explain:

Work Experience

Name of Employer:

Dates of Employment
(month and year) :

Street Address :

City :

State :

Zip :

Position Title :

Fulltime Parttime

Supervisor & Title :

Telephone :

Reason for leaving :

Salary :

Do you have any objection to our contacting your previous employers to verify the above?: Yes No

If you are considered for employment, may we conduct a criminal background check, a check of your current child protective services status as well as your qualifications, character and record of employment?: Yes No

Does OAR employ anyone related to you by blood, marriage, or adoption? : Yes No

If so, please provide name(s) and work location :

References

Name:

Title :

Relation :

Address :

Telephone :

Name:

Title :

Relation :

Address :

Telephone :

Name:

Title :

Relation :

Address :

Telephone :

Resume

Attach File:
Upload MS Word file(.doc) only. Max size limit 150 Kb

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. By signing this document you acknowledge an understanding that employees of OAR are employed “at will” which means that you or OAR may terminate the employment relationship at any time, with or without cause.