WLS Employment Application

I. PERSONAL BACKGROUND

Full Name

Current Address

Social Security Number

Email Address
*A Valid & Current email address is required for on-line application submissions only. This email address may be used for additional correspondence from Whole Life Services, Inc.

Home Phone Number
*If this does not apply, please fill in each field with 0's.

Mobile Phone Number
*If this does not apply, please fill in each field with 0's

What position are you applying for?

Desired Salary

Available Start Date

What is your current employment status?x

Employed Self-Employed Unemployed Student

May we contact your current Employer?

Yes No

Have you ever applied to this company before?

Yes No

When did you last apply?

Are you willing to work overtime?

Yes No

Are a Minor (under age 18)?

Yes No

Are you able to produce the age/work certificate necessary to obtain employment?

Yes No

Upon hire, are you able to submit verification of your legal right to work in the US?

Yes No

Have you ever been convicted of a Felony?
*This question does not apply to convictions that have been sealed or expunged. A conviction record will not necessarily be a bar

Yes No

Please fully describe the Felony conviction(s); listing the nature of the offense, your age at the time, and your rehabilitation since the offense(s);

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II. EDUCATIONAL BACKGROUND

Name of High School

Grade Completed

High School Address

Graduated?

Yes No

Major Areas of Study

Name of College or University

Level Completed

College or University Address

Graduated?

Yes No

Major Areas of Study

Other Education: Technical School or Other Training/Schooling

Level Completed/Certificate or Degree Earned

Address

Graduated?

Yes No

Major Areas of Study

Please list any Specialized Technical or Special Skills (IE: Computer Programming, Language, Equipment Operation, Special tools or Machines used):

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III. WORK EXPERIENCE

Please List your last 4 Employers, (starting with your present or last place of employment):

Employer#1 Name
*Give the name of your Current or Most Recent place of employment

Position

Employer#1 Address

Employment Start Date:

Your Current Status with this Employer:

I am currently employed here I am no-longer employed here

Employment End Date:

Name of Supervisor

Supervisor's Phone Number

Salary

Reason for leaving

Employer#2 Name
*Give the name of your Second Most Recent Employer

Position

Employer#2 Address

Employment Start Date:

Your Current Status with This Employer:

I am currently employed here I am no-longer employed here

Employment End Date:

Name of Supervisor

Supervisor's Phone Number

Salary

Reason for leaving

Employer#3 Name
*Give the name of your Third Most Recent Employer

Position

Employer#3 Address

Employment Start Date:

Your Current Status with this Employer:

I am currently employed here I am no-longer employed here

Employment End Date:

Name of Supervisor

Supervisor's Phone Number

Salary

Reason for leaving

Employer#4 Name
*Give the Name of your Fourth Most Recent Employer

Position

Employer#4 Address

Employment Start Date:

Your Current Status with this Employer:

I am currently employed here I am no-longer employed here

Employment End Date:

Name of Supervisor

Supervisor's Phone Number

Salary

Reason for leaving

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IV. REFERENCES

Give the names of 3 people (not related to you), who can verify your work ethic/capabilities (a supervisor and/or someone you have worked with)

Person#1 First & Last Name

Their Occupation

Person #1 Address

Person#2 Phone Number

Number of Years Known

Person#2 First & Last Name

Their Occupation

Person#2 Address

Person#2 Phone Number

Number of Years Known

Person#3 First & Last Name

Their Occupation

Person#3 Address

Person#3 Phone Number

Number of Years Known

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V. APPLICATION QUESTIONS

1. Why are you applying for this position?

2. How would people you have worked with describe you?

3. Describe your ideal work environment or "The Perfect Job"

4. Do people ever come to you for help with solving problems?

Yes No

Please describe why:

5. Tell us how the quality of your work impacts others around you:

6. People react differently when job demands are constantly changing. How would you react to this?

7. We believe that this organization should work as a Team. what is essential for a team to be successful?

8. How would you react if an Individual that you support (or their family member) told you that they do not like the level of care that you are giving them?

9. What do you do when you feel that someone is not listening to you?

10. What type of events cause you to have stress on the job?

11. 2 X 7=?

12. 5 + 5= ____ + 2=____ ÷ 6=?

13. 1.5 + 3 + .75 + 1.25=?

14. Convert to a Decimal: 3/4=?

15. Convert to a Decimal: 1/4=?

16. $10.00 - $4.75=?

17. $20.00 - $6.89=?

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VI. AVAILABILITY QUESTIONNAIRE

SECTION-A: Are you AVAILABLE to Work during the 3 Shifts listed below? (Check YES or NO):

1. Monday- Friday 9AM-5PM?

Yes No

2. Weekends?

Yes No

3. Holidays?

Yes No

SECTION-B: For each Day of the Week Listed Below, Check Every Shift that you are AVAILABLE to Work (Check all that apply):

SUNDAY AVAILABILITY:
*For the Shifts that you are NOT AVAILABLE: LEAVE BLANK