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EIHAB Human Services:
Application for Employment

Eihab is an equal opportunity employer. Eihab does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service or any other characteristic protected by law.

Please carefully read and answer all questions. You will not be considered for employment if you fail to completely answer all the questions on this application.

You may attach a résumé, but all questions must be answered.

Applying State: Select One
.

If yes, please specify dates of employment 

 to

How did you hear about us?

Personal Data

Are you 18 years or older?:
Do you have a driver's license?
If Yes, Which State?
Can you work overtime?
Have you been driving for a minimum of 3 years?
Hours
Shifts
Are you authorized to work in the U.S. on an restricted basis?
Will you now or in the future require sponsorship for employment visa status?
Have you been told the essential functions of the job or have you been given a copy of the job description listing the essential functions of the job?
Can you perform these essential functions of the job with or without reasonable accomodation?

Educational Qualifications

Please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training.

Work History

Include your last Seven (7) years of employment history. Start with your present or most recent employment and work back.

Currently Employed Here?
May We Contact this Employer?
Currently Employed Here?
May We Contact this Employer?
Currently Employed Here?
May We Contact this Employer?

References

Please list three professional references not related to you, with full name, contact info, and relationship, whom you have known at least three (3) years.

Please Read Carefully Before Signing

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Eihab to hire me. If I am hired, I understand that either Eihab or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Eihab has the authority to make any assurance to the contrary.I attest with my signature below that I have given to Eihab true and complete information on this application. No requested information has been concealed. I authorize Eihab to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

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