THE NORTH STAR HISTORIC CONSERVANCY
12075 AUBURN ROAD, GRASS VALLEY, CA 95949 530-477-7126
Employment Application |
NSHC is an Equal Opportunity Employer and is committed to excellence through diversity. | Please print or type. The application must be fully completed to be considered. Please complete each section, even if you attach a resume. | |||||
Personal Information | |||||||
Name | |||||||
Address | City | State | Zip | ||||
Phone Number | Mobile Number | Email Address | |||||
Are You A U.S. Citizen? | Have You Ever Been Convicted Of A Felony? | ||||||
Yes | No | Yes | No | ||||
If Selected For Employment Are You Willing To Submit to a Pre-Employment Drug Screening Test? | |||||||
Yes | No | ||||||
Position | |||||||
Position You Are Applying For | Available Start Date | Available PT / FT Work? | |||||
Special Skills for Position
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Education | |||||||
School Name | Location | Years Attended | Degree Received | Major | |||
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References | |||||||
Name | Title | Company | Phone | ||||
Employment History | |||||||
Employer (1) | Job Title | Dates Employed | |||||
Work Phone | Starting Pay Rate | Ending Pay Rate | |||||
Address | City | State | Zip | ||||
Employer (2) | Job Title | Dates Employed | |||||
Work Phone | Starting Pay Rate | Ending Pay Rate | |||||
Address | City | State | Zip | ||||
Employer (3) | Job Title | Dates Employed | |||||
Work Phone | Starting Pay Rate | Ending Pay Rate | |||||
Address | City | State | Zip | ||||
Employer (4) | Job Title | Dates Employed | |||||
Work Phone | Starting Pay Rate | Ending Pay Rate | |||||
Address | City | State | Zip | ||||
Employer (5) | Job Title | Dates Employed | |||||
Work Phone | Starting Pay Rate | Ending Pay Rate | |||||
Address | City | State | Zip | ||||
Signature Disclaimer | |||||||
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.
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Name (Please Print) | Signature | ||||||
Date | |||||||