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United Way of the Midlands
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APPLICATION FOR EMPLOYMENT

Personal Information

Name
Address
Are you legally eligible to work in the US?
Are you a veteran?

Position

MM slash DD slash YYYY
Employment desired
Referral Source:

Employment History

Provide the following information for your past and current employers, starting with the most recent.

Address

Dates Employed

MM slash DD slash YYYY
MM slash DD slash YYYY

Hourly Rate/Salary Starting

Hourly Rate/Salary Final

May we contact for reference?

Provide the following information for your past and current employers, starting with the most recent.

Address

Dates Employed

MM slash DD slash YYYY
MM slash DD slash YYYY

Hourly Rate/Salary Starting

Hourly Rate/Salary Final

Hidden
Add another employer 2:
Address

Dates Employed

MM slash DD slash YYYY
MM slash DD slash YYYY

FInal

Hourly Rate/Salary Starting

Hourly Rate/Salary Final

Hidden
Add another employer 3:
Address

Dates Employed

MM slash DD slash YYYY
MM slash DD slash YYYY

FInal

Hourly Rate/Salary Starting

Hourly Rate/Salary Final

Hidden
Add another employer:
Address

Dates Employed

MM slash DD slash YYYY
MM slash DD slash YYYY

FInal

Hourly Rate/Salary Starting

Hourly Rate/Salary Final

(2nd)May we contact for reference?
Address

Dates Employed

MM slash DD slash YYYY
MM slash DD slash YYYY

Hourly Rate/Salary Starting

Hourly Rate/Salary Final

(3)May we contact for reference?
Address

Dates Employed

MM slash DD slash YYYY
MM slash DD slash YYYY

Hourly Rate/Salary Starting

Hourly Rate/Salary Final

(4)May we contact for reference?

Educational Background

Address
Hidden
Add another school:
Address
Hidden
Add another school 2:
Address
Hidden
Add another school 3:
Address

Reference

Name

Current or Prior Supervisors

Current or Prior Supervisors

I understand that if I am employed, any misrepresentation or material omission made by me on this application may result in cancellation of this application or immediate discharge from the employer’s service, whenever it is discovered.

I give the employer the right to contact and obtain information from all references, employers, educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the employer and its representatives for seeking, gathering and using such information and all other persons, corporations or organizations for furnishing such information.

The employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state or federal law. United Way of the Midlands is an equal opportunity employer.

I understand that if I am hired, I will be required to provide proof of identity and legal work authorization.

I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.

MM slash DD slash YYYY
Max. file size: 300 MB.
Max. file size: 300 MB.
United Way of the Midlands
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UNITED WAY OF THE MIDLANDS | 2201 FARNAM STREET | OMAHA, NE 68102 | 402-342-8232

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