Job Application (TEST)

Personal Information

First name (required)

Last name (required)

Email address (required)

Address (required)

City (required)

State (required)

Zip Code (required)

Telephone (required)

What position are you applying for? (required)

Eligibility Questions

Have you ever been employed, volunteered, or been an Intern with our Agency?

YesNo

If yes, what was your title/position?

Are you related to anyone employed by or associated with the Agency?

YesNo

If Yes, Who?

Have you ever applied here before?

YesNo

Have you been convicted of a felony?

YesNo

If yes, please provide date and explanation of conviction:

Are you bilingual?

YesNo

In what languages?

Most of our positions require non-traditional hours to include nights and weekends. Some positions require frequent travel within the designated service area and occasional out-of-area travel utilizing a personal vehicle. If you are unavailable to work non-traditional hours and do not have access to a vehicle, your application may not be considered.

Do you have regular access to an automobile?

YesNo

Are you willing to travel?

YesNo

Are you willing to work nights?

YesNo

Are you willing to work weekends?

YesNo

Do you have a valid driver's license?

YesNo

State in which your Driver's License was issued:

Can you provide proof of valid vehicle insurance?

YesNo

Date you can begin employment

What is your expected rate of compensation?

Education History

Highest level of education completed (required)
High School Diploma or GEDCertificationsAssociate's DegreeBachelor's DegreeMaster's Degree

Please list your certifications and/or major(s)

Proof of education is required. Can you provide proof of your education?

YesNo

Employment History

Please provide your employment history for the past five (5) years.

We participate in eVerify. Are you authorized to work in the US?

YesNo

Are you currently employed?

YesNo

Current / Most Recent Employer

Employer name

Address

Telephone

Job title

Date from

Date to

Describe duties

Why did you leave?

May we contact?

YesNo

Previous Employer #2

Employer name

Address

Telephone

Job title

Date from

Date to

Describe duties

Why did you leave?

May we contact?

YesNo

Previous Employer #3

Employer name

Address

Telephone

Job title

Date from

Date to

Describe duties

Why did you leave?

May we contact?

YesNo

Have you ever been terminated from a previous job?

YesNo

References

Please provide three (3) character references and two (2) MUST be employment references.

Reference name #1

Reference organization

Reference telephone

Reference e-mail address

Reference name #2

Reference organization

Reference telephone

Reference e-mail address

Reference name #3

Reference organization

Reference telephone

Reference e-mail address

Additional Questions

List all the computer software that you are proficient in and describe your experience and skills in each.

In your own words, please describe for us your understanding of the dynamics of sexual assault.

In your own words, please describe for us your understanding of the dynamics of family violence / intimate partner violence.

Have you received services from The Purple Door within 2 years of today's date?

YesNo

Certification

I acknowledge the importance of telling the truth on this application and any associated documents (herein "application"). I affirm that all of the information provided by me on this application is true to the best of my knowledge. The information is also not intended to mislead about my qualifications or background. If I have omitted any information or provided information that is false or misleading, my application will be rejected, and I will not be eligible for employment. In addition, if it is later learned that any information on this application is false or misleading, that I may be subject to disciplinary action up to and including immediate discharge.

I authorize my previous employers, schools, or persons listed as references to give any information regarding employment or educational record. I agree that this agency and my previous employers will not be held liable in any respect if a job offer is not extended, or is withdrawn, or employment is terminated because of false statements, omissions, or answers made by myself on this application. In the event of any employment, I will comply with all rules and regulations set in any communication distributed to the employee.

I understand that employment with the employer is "at will" which means that either the employer, or I, may terminate the employment relationship at any time, with or without prior notice.

I understand and acknowledge that my electronic signature constitutes a valid signature. To electronically sign, please type your full name below: (required)

Electronic Application Date (required)