Application for Employment

L.L. BRANDON III TRANSITIONAL HOME FOR BOYS
1 WESTWOOD PARK CIRCLE
SHREVEPORT, LA 71109
(318) 631-3449
(318) 631-6361 (fax)

Application for Employment
The L.L. Brandon III Transitional Home for Boysis an Equal Opportunity Employer committed to excellence through diversity. Employment offers are made on the basis of qualificationsand without regard to race, sex, religion, nationalor ethnic origin, disability, age, veteran status, or sexual orientation.

PLEASE TYPE OR PRINT. Complete the entire application. You may attach a resume, but all questions and blanks must be completedor your application will be deemed incomplete and may not be considered. Please fill out each box (Donotjust indicate “See Resume.”) Applications with missing or invalid job numbers will not be considered for any position.
Position Applying For:
Name :
First Middle Last
Other names under which you have attended school or been employed:
Street Address City State ZIP
Social Security Number:
Home Phone:
Work Phone:
Other Phone:
Are you eligible to work in the United States?
- Yes
- No
Are you 18 years of age or older?
- Yes
- No
If NO, what is your current age?
Have you ever been convicted of a felony?
- Yes
- No
If required for position, do you have a valid driver’s license?
- Yes
- No
If YES,
State of issuance: license # expiration date:

Supervisor’s
Name: Title: Phone #:
Other Reference
Name: Title: Phone #:
Other Reference
Name: Title: Phone #:
Primary duties:
Reason for Leaving:
Dates Employed (most recent position)
From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
- Full time
- Part-time
If part-time, # hrs./wk: 0
Title:
Organization Name and Address:
Starting Salary
Final Salary
Supervisor’s
Name: Title: Phone #:
Other Reference
Name: Title: Phone #:
Primary duties:
Reason for Leaving:
PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION.
I certify that the information on this application and its supporting documents is accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later date. I authorize LL Brandon III Transitional Home for Boys to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers, without liability, to make full response to any inquiries in connection with this application for employment. If requested, I agree to submit to a criminal background investigation, and/or screening for illegal substances upon conditional offer of employment. I understand that this document is NOT and offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment.
I understand that staff employees of L L Brandon III Transitional Home for Boys serve at-will, and the employment relationship may be terminated at any time by either party, or any or no reason, other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the United States, and to comply with company and departmental regulations. I understand that the first SIX MONTHS of regular employment represent a probationary period, during which I may be terminated without cause.
Applicant Signature:
Date:
Date Format: MM slash DD slash YYYY

Step 1 of 3

L.L. BRANDON III TRANSITIONAL HOME FOR BOYS
1 WESTWOOD PARK CIRCLE
SHREVEPORT, LA 71109
(318) 631-3449
(318) 631-6361 (fax)

EDUCATION

Skills:

PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION.

Application for Employment

Step 1 of 3

L.L. BRANDON III TRANSITIONAL HOME FOR BOYS 1 WESTWOOD PARK CIRCLE SHREVEPORT, LA 71109 (318) 631-3449 (318) 631-6361 (fax)

Application for Employment

EDUCATION

Skills:

PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION.

L.L. BRANDON III TRANSITIONAL HOME FOR BOYS
1 WESTWOOD PARK CIRCLE
SHREVEPORT, LA 71109
(318) 631-3449
(318) 631-6361 (fax)