Our Vision ~
"A community where every youth is safe, healthy, self-sufficient and connected with family."

Application for Employment

It is our policy to comply with applicable state and federal laws prohibiting discrimination in employment based on Age (40 and over), Ancestry, Color, Religious Creed, Denial of Family and Medical Care Leave, Disability (mental and physical) including HIV and AIDS, Marital Status, Medical Condition (cancer and genetic characteristics), National Origin, Race, Religion, Sex, Sexual Orientation, or any other protected classification.

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Personal Information

First Name:		MI:
Last Name:
Email:
Address:

City:
State:
Zip:
Primary Phone:		() -
Secondary Phone:		() -

Position(s) Desired:	1.
	2.
	3.
	4.

How did you hear about this position?
If OTHER, please explain:

Referred by:
Nature of Aquaintance:

Are you a US Citizen or otherwise authorized to work in the U.S.?	Yes No
Do you possess a valid California Driver's License?	Yes No
Are you over 18 years of age?	Yes No
Have you ever been convicted of a crime? (Conviction does not necessarily disqualify applicant from employment)	Yes No
If yes, please explain:

Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accomodations?	Yes No
If no, describe the functions that cannot be performed: (Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility test.)

Education

High School
	Name of School
	Location
	Major/Minor
	Degree/Units Completed

College/University
	Name of School
	Location
	Major/Minor
	Degree/Units Completed

College/University
	Name of School
	Location
	Major/Minor
	Degree/Units Completed

Other Training/Education
	Name of School
	Location
	Major/Minor
	Degree/Units Completed

List certificates of professional achievement, association membership, credentials or licenses that are current and relative to the position(s) for which you are applying:

List skills or talents, which you possess, that may be useful in the position(s) for which you are applying:

Employment History

Have you ever applied to Stanford Home for a job before?	Yes No
If yes, when? / /

List names and addresses or phone number of three references other than relatives who have knowledge of your work performance.

Reference #1
	Name
	Address:
	Phone:	() -
	Nature of Acquaintance: (Supervisor, Teacher, etc.)
	Years Acquainted:

Reference #2
	Name
	Address:
	Phone:	() -
	Nature of Acquaintance: (Supervisor, Teacher, etc.)
	Years Acquainted:

Reference #3
	Name
	Address:
	Phone:	() -
	Nature of Acquaintance: (Supervisor, Teacher, etc.)
	Years Acquainted:

List below all present and past employment starting with your most recent employer (to encompass at least 5 years). Account for all periods of unemployment. You must complete this section even if attaching a resume.

Most Recent Employment
	Name:
	Address:

	City:
	State:
	Zip:
	Telephone:	() -
	Date Started:	/ /
	Job Title:
	Type of Work:
	Date Left:	/ /
	Supervisor:	(Name and Title)
	Reason for Leaving:
	May we contact this employer for a reference? Yes No

Previous Employment
	Name:
	Address:

	City:
	State:
	Zip:
	Telephone:	() -
	Date Started:	/ /
	Job Title:
	Type of Work:
	Date Left:	/ /
	Supervisor:	(Name and Title)
	Reason for Leaving:
	May we contact this employer for a reference? Yes No

Previous Employment
	Name:
	Address:

	City:
	State:
	Zip:
	Telephone:	() -
	Date Started:	/ /
	Job Title:
	Type of Work:
	Date Left:	/ /
	Supervisor:	(Name and Title)
	Reason for Leaving:
	May we contact this employer for a reference? Yes No

PLEASE READ CAREFULLY

Check each paragraph and certify below.

	I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
	I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between Stanford Home for Children and myself. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or Stanford Home for Children and that no promises or representations contrary to the foregoing are binding on Stanford Home for Children unless made in writing and signed by me and Stanford Home for Children's designated representative.
	Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by Stanford Home for Children, I am entitled to copies of any such public records unless I mark the check box below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the box below.
	I waive receipt of a copy of any public records described in the paragraph above.
	I hereby authorize Stanford Home for Children to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports or other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release Stanford Home for Children, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigations or disclosure.
	Checking this box functions as my signature and certifies that I have read and agree to the above terms of this employment application.

Applicant's Name: Date: / /



If you have any questions or need assistance with this application please contact Human Resources at: (916) 344-0199 or send an email to: resumes@stanfordhome.org

Stanford Home is a Sacramento-based, social services, 501(c)(3) non profit charitable organization.
We rely on community support to continue serving children and families in need.