Application

Job Application Form

Please include a narrative statement of maximum two typewritten pages, addressing the preferred qualifications for each position of interest.

All fields marked with * are required.

I. Personal Information

Personal Title:*
Mr.Mrs.Ms.Dr.Other.

First Name:*

Middle Initial:

Last Name:*

Present Address*

City/Town*

State/Province*

Zip/Postal Code*

Daytime Telephone*

Evening Telephone

Email Address*

For what position are you applying?*

How did you find out about this employment opportunity?*
NewspaperPamplin Park WebsiteOn-Site VisitVECVAMCraigslist.orgALHFAMOther

[group how-found]
Please specify name of the newspaper, publication or website.

[/group]

What date are you available to begin work?*

May we contact your current employer in reference to this application?*
YesNo

Have you ever been convicted of a felony?*
YesNo

[group yes-felony]
Please explain:

[/group]

II. Educational Information

Do you have a high school diploma or GED?*
YesNo

[group yes-diploma]

1. College Name*

[group college-1]
Year Completed*

Major*

Degree Earned*

[/group]

2. College Name

[group college-2]
Year Completed*

Major*

Degree Earned*

[/group]

3. College Name

[group college-3]
Year Completed*

Major*

Degree Earned*

[/group]

[/group]

III. Employment History

Do you have prior employment history?
YesNo

[group has-history]

Please list your last three positions held, beginning with your current or most recent employer first.

1. First Company:*

[group company-1]
Phone:*

Position Held:*

Date From:*

Date To:*

Wage/Salary:

Reason for Leaving:*

[/group]

2. Second Company:

[group company-2]
Phone:*

Position Held:*

Date From:*

Date To:*

Wage/Salary:

Reason for Leaving:*

[/group]

3. Third Company:

[group company-3]
Phone:*

Position Held:*

Date From:*

Date To:*

Wage/Salary:

Reason for Leaving:*

[/group]
[/group]

IV. References

Please do not include relatives or any direct supervisors.

1. Name:*

[group reference-1]
Address:*

Years Known:*

Phone Number:*

Occupation:*

Relationship:*

[/group]

2. Name:*

[group reference-2]
Address:*

Years Known:*

Phone Number:*

Occupation:*

Relationship:*

[/group]

3. Name:*

[group reference-3]
Address:*

Years Known:*

Phone Number:*

Occupation:*

Relationship:*

[/group]

V. Narrative Statement

Please provide a narrative statement explaining your qualifications for the position. Statements should be 1-2 pages in length (7,000 character max).

Character count: 0

VI. Resume

Please attach your resume. Acceptable file formats include doc, docx, pdf, and txt.

VII. Additional Materials

If you have other pertinent files that you feel would be helpful, please include them with your application. File size is restricted to 4mb.

Please complete all required information. Also refer to the vacancy announcement for further application instructions. False statements on this application will be considered grounds for dismissal or rejection of this application.

It is the policy of Pamplin Historical Park to maintain pre-employment screening practices designed to prevent hiring individuals who use illegal drugs or individuals whose use of illegal drugs or alcohol indicates a potential for impaired or unsafe job performance. Pamplin Historical Park is an equal opportunity employer.

I confirm that the information given on this form is true & accurate.
I AgreeI Disagree