Susanne BeckerSusanne Becker312008-07-04T23:17:00Z2008-08-08T01:58:00Z36643789318444511.8134 The Housing Authority of the County of Scotts Bluff, NE89-A Woodley Park RoadGering, Nebraska  69341-1638Equal Employment Opportunity Employer Application for Employment                      = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = Date: ___________________________         Position Applied for ______________________________________________________ Name: _______________________________________________  Social Security No. _____________________________________ Present Address: _____________________________________________________________________________________________                                   (street)                                                                      (city)                                             (state)                    (zip) Phone No. ____________________________________  Valid Driver’s License # ________________________________________ Emergency Contact: Name ________________________________ Phone: ____________________ Relationship _______________ Willing to work:  full-time _____; part-time _____; weekends ______.  Rate of pay expected ____________/hr. Date available to start work:  _________________________. Circle last year completed:    Name of  SchoolElementary School5678 High School1234 College1234  Additional Training                 Employment HistoryCompanyName/Address/Phone #& SupervisorDates ofEmploymentDescription of workStarting / EndingwagesReason for Leaving      CompanyName/Address/Phone #& SupervisorDates ofEmploymentDescription of workStarting / EndingwagesReason for Leaving      CompanyName/Address/Phone #& SupervisorDates ofEmploymentDescription of workStarting / EndingwagesReason for Leaving      May we contact your most recent employer? ______________ Have you ever been convicted of a misdemeanor or a felony offense? __________________(conviction will not necessarily disqualify an applicant from employment) Have you ever been dismissed from employment for misconduct, or have you ever resigned on request to avoid discharge? _________  If yes, please explain  __________________________________________________________________________________________    Have you served in the armed forces?  ___________ Branch ____________________________ Dates ________________________ What do you see as your strengths?   What do you see as your weaknesses?   List any additional skills or interests in training you may have.   Please list three (3) references that we may contact: Name _________________________________ How to reach _____________________________________ Name _________________________________ How to reach _____________________________________ Name _________________________________ How to reach _____________________________________ READ THIS APPLICATION AND YOUR ANSWERS CAREFULLY BEFORE SIGNING BELOW The Housing Authority maintains a drug free work place.  Pre-employment and random testing is a part of the Housing Authorities drug policy. Be advised that failure to pass the pre-employment drug test will void your application for any Housing Authority employment position. Also, be advised that if you are a participant in the Public Housing or Section 8 rental assistance programs, your failure to pass the pre-employment drug test or random testing during employment, will result in termination of your assistance. AFFIRMATION AND AUTHORIZATION I affirm that I am a legal resident of the United States of America.  The facts set forth in my application are true and complete.  I authorize any company or person listed in the foregoing application to give any and all information regarding my employment, credit or any other information, whether personal or otherwise, that may or may not be on their records, and release said company or person from all liability for any damage whatsoever that may issue from furnishing such information to the Housing Authority of the County of Scotts Bluff, NE.  I understand that if hired, false statements on this application shall be considered sufficient cause for terminating employment.  Signature ___________________________________________,                         Date ___________________      This application was received by _________________________,                         Date ___________