Granville County's Domestic Violence and Sexual Assault Agency
24/7 Crisis Lines: English (919)-693-5700; Espanol (919)-690-0888
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Menu
HOME
ABOUT US
STAFF
BOARD
CONTACT US
LEARN
NEWS & EVENTS
DOMESTIC VIOLENCE
SEXUAL ASSAULT
HUMAN TRAFFICKING
STALKING
ONLINE SAFETY
GET INVOLVED
DONATE
VOLUNTEER/INTERN
EMPLOYMENT
SERVICES
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Name
*
First
Last
Mailing Address
(City, State, Zip)
Email Address
Cell Phone Number
Home Phone Number
Social Security Number
How were you referred to Families Living Violence Free (FLVF)?
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Agency
Walk-in
Employee
Other
Please specify your referral source (employee name, agency)
Position applied for
Desired Pay
Pay type
per hour
per month
Are you 18 years of age or older?
Yes
No
Are you authorized to work in the United States?
Yes
No
Do you have any relatives employed by FLVF?
Yes
No
Relative's name
Have you been convicted of a felony which has not been expunged, annulled, or sealed by a court?
Yes
No
Were you previously employed by Families Living Violence Free?
Yes
No
If yes, please explain.
Did you graduate high school?
Yes
No
Name of high school
City, State, andZip
Did you graduate college?
Yes
No
Name of college
City, State, and Zip
Major
Skills and Qualifications: Please list any certifications, credentials, training, affiliations, and awards which are relevant to the job-skills of the position for which you are applying.
Are you available to work
Full Time
Part Time
Employment History
NOTE: Please complete ALL sections in full (Do not attach resume in lieu of completing this section)
Employer Name and Address
From
To
Title
Supervisor
Phone Number of Employer/Company
Starting Salary
Ending Salary
List Primary Responsibilities
Reason for leaving
Employer Name and Address
From
To
Title
Supervisor
Phone Number of Employer/Company
Stating Salary
Ending Salary
List Primary Responsibilities
Reason for leaving
Employer Name and Address
From
To
Title
Supervisor
Phone Number of Employer/Company
Starting Salary
Ending Salary
List Primary Responsibilities
Reason for leaving
May we contact your present employer?
Yes
No
Professional References (Please list names and telephone numbers )
1. Name
Phone Number
2. Name
Phone Number
3. Name
Phone Number
I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I understand that any falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. I authorize a thorough investigation of my past employment and activities, agree to cooperate in such investigation and release from all liability or responsibility all persons and corporations requesting or supplying such information. I hereby agree to submit to any lawful drug or background screening that may be required as a condition of employment or continued employment. I understand that all offers of employment are conditional upon the successful completion of the testing and screening procedures and that refusal to submit to such testing during the course of my employment may result in disciplinary action, up to and including discharge. I understand and agree that my employment and compensation are terminable at- will either at my option or at the option of FLVF, that I am not being employed for any specified time, and that this application is not intended to be a contract for continued employment.
Applicant's Signature
Date
Submit