APPLICATION FOR EMPLOYMENT Myers Family Home Inc. GENERAL INFORMATION Full Name * First Name Last Name E-mail * Address * Street Address Street Address Line 2 City State / Province Postal / Zip Code Please SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d’IvoireCroatiaCubaCyprusCzech RepublicDemocratic Republic of the CongoDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNagorno-KarabakhNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandTurkish Republic of Northern CyprusNorthern MarianaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRepublic of the CongoRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSouth SudanSpainSri LankaSudanSurinameSvalbardSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTransnistria PridnestrovieTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsIsle of ManUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Phone Number * – Area Code Phone Number Last 4 of SSN * If hired, can you furnish proof you are eligible to work in the U.S.? * Yes No Are you at least 21 years of age or older? * Yes No Have you ever worked for Myers Family Home? * Yes No If yes, when & where Back Next JOB INTEREST Position applying for * Referred by * Employment AgencySchool/CollegeCommunity OrganizationCurent EmployeeCraigslistOther internet siteOther source Check each day you are available to work (please note that most positions require weekend availability) * Monday Tuesday Wednesday Thursday Friday Saturday Sunday Type of employment desired (check all that apply) * Full-time Part-time Temporary Summer only Is there any time that you cannot work? Back Next Employment History Information Work History: Current and previous 2 employers (most current employer listed first) Most Recent Employer Name First Name Last Name City, State Position Held Start Date – Month – Day Year Date Finished – Month – Day Year Employer phone – Area Code Phone Number Supervisor name First Name Last Name Describe your duties: Reason for leaving NEXT EMPLOYER Employer Name First Name Last Name City, State Position Held Start Date – Month – Day Year Date Finished – Month – Day Year Employer phone – Area Code Phone Number Supervisor name First Name Last Name Describe your duties: Reason for leaving NEXT EMPLOYER Employer Name First Name Last Name City, State Position Held Start date – Month – Day Year Date Finished – Month – Day Year Employer phone – Area Code Phone Number Supervisor name First Name Last Name Describe your duties: Reason for leaving Back Next Additional Information Have you ever been convicted of a felony? * Yes No If yes, please give date and explain Have you ever been employed under a name other than the name used on this application? * Yes No If yes, please explain Back Next EDUCATION INFORMATION HIGH SCHOOL Name & City/State of High School * Course of Study/ Degree Earned * Did you graduate? * Yes No Attending COLLEGE OR UNIVERSITY Name & City/State of College or University Course of Study/ Degree Earned Did you graduate? Yes No Attending OTHER Name & City/State of OTHER (specify) Course of Study/ Degree Earned Did you graduate? Yes No Attending You should hire me because… * Resume Enter the message as it’s shown * Submit Should be Empty:
