HADC EMPLOYMENT APPLICATION

HOUSING AUTHORITY OF DEKALB COUNTY
ONLINE APPLICATION FOR EMPLOYMENT

HADC thanks you for your interest in employment with us.
If you would like to fax this form to us either, 1) print this page, fill it out, print and fax; or 2) fill this form out online, print and fax.
Fax Number: (404)270-2643.

Step 1: Company:

Position(s) Applied For Date (00/00/00)

Referral Source Name of Source (If Applicable)

Name:


FIRST	LAST	M.I.

Address:

Street City

State (please enter US Postal abbreviation - for example,GA) Zip

Phone Social Security Number

If necessary, the best time to call you at home is: AM PM

May we contact you at work? YES NO

If yes, work number (with area code) and best time to call Time: AM PM

If you are under 18, can you furnish a work permit? YES NO

Have you filed an application here before? YES NO

If yes, give date: (ex.: 01/22/05)

Have you been employed here before? YES NO

If yes, give dates: from to (ex.: 01/22/05)

Do you have any friends or relatives working for the Authority? YES NO

If yes, who? Relationship:

Are you eligible for employment in this Country? YES NO
(Proof of U.S. Citizenship or immigration status will be required upon employment)

Date available for work: Salary Expected/Needed: $

Type of employment desired: Full Time Part Time Temporary Seasonal

Are you on lay-off and subject to recall?	YES NO
Do you have access to a servicable personal vehicle if your position requires the use?	YES NO
Are you able to meet the attendance requirements of the position?	YES NO
Will you work overtime if required?	YES NO
Have you ever been bonded?	YES NO
Have you been convicted of a felony in the last seven years, or have a felony charge pending against you? (Such conviction may be relevant if job related, but does not bar you from employment)	YES NO

If YES, please explain:

Driver's license number and type: State

Employment History
List your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military experience.
Explain any gaps in employment in comments section below.

Employer #1

Employer	Telephone
Address	Dates Employed
Job Title	Hourly Rate/Salary - Starting
Immediate Supervisor and Title	Hourly Rate/Salary - Final

Reason for Leaving

May we contact for Reference?
Yes No Later
Summarize the nature of the work performed and job responsibilities

Employer #2

Employer	Telephone
Address	Dates Employed
Job Title	Hourly Rate/Salary - Starting
Immediate Supervisor and Title	Hourly Rate/Salary - Final

Reason for Leaving

May we contact for Reference?
Yes No Later
Summarize the nature of the work performed and job responsibilities

Employer #3

Employer	Telephone
Address	Dates Employed
Job Title	Hourly Rate/Salary - Starting
Immediate Supervisor and Title	Hourly Rate/Salary - Final

Reason for Leaving

May we contact for Reference?
Yes No Later
Summarize the nature of the work performed and job responsibilities

Employer #4

Employer	Telephone
Address	Dates Employed
Job Title	Hourly Rate/Salary - Starting
Immediate Supervisor and Title	Hourly Rate/Salary - Final

Reason for Leaving

May we contact for Reference?
Yes No Later
Summarize the nature of the work performed and job responsibilities

Comments (including any explanation of any gaps in employment)

Skills and Qualifications - Summarize special skills and qualifications acquired from employment
or other experiences that may qualify you to work with the Authorities

Educational Background

A. List the last three (3) schools attended, starting with the last one. B. List number of years completed. C. Indicated degree or diploma earned, if any. D. Grade Point Average or Class Rank and E. Major and Minor Field of Study (if applicable)

A. School	B. Years	C. Degree	D. GPA/Rank	E. Major	E. Minor

List any trade or technical training.

A. School	B. Years	C. Degree	D. GPA	E. Field of Study

List any foreign language(s) and check the box that best describes your skill level.

Language	Read and Write	Read and Speak	Read Only	Speak only

References

List name and telephone number of three business/work references who are not related to you and are not previous supervisors.
If not applicable, list three school or personal references who are not related to you.

Name	Telephone	Years Known

List professional, trade, business, or civic associations and any offices held. (Exclude memberships which would reveal sex, race,
religion, national origin, age, color, disability or other protected status.)

Organization	Offices Held

List special accomplishments, publications, awards. (Exclude memberships which would reveal sex, race,
religion, national origin, age, color, disability or other protected status.)

List any additional information you would like us to consider.