Application for Employment 12 Application Must be Completed in Full for ConsiderationDate* MM slash DD slash YYYY Name* First Middle Last Position Applied For*Please be specific If you'd like to apply for any other positions, please list them herePlease be specific As noted on our website we seek applicants who will help us meet our responsibilities to those we serve. To meet this objective, our interview/hiring process is intentional to find individuals who could be the best fit for positions at Emerge. During the process we may determine an applicant’s knowledge, skills and abilities would be a better fit for a position which is different from what was indicated on this application. When this occurs we will have a conversation with applicants about other opportunities identified during the process. Thank you for your interest in employment with us and your understanding of our process.Please specify the schedule you are applying for*Schedule listed on the job posting Salary Desired* Type of Employment Desired (listed on job posting)*If you are interested in the Emergency Services - On Call position, please select the "On Call" option below to indicate which days and shifts you would be available to work. Full Time On Call On-Call Employees at Emerge work at either our emergency shelter or at our hotline location. Shift coverage may be needed when full- or part-time employees are out due to scheduled leave, or unexpected absences or while positions are being filled. On-Call employees may know what shifts they will be working with advance notice (up to 2 or 3 weeks). It also may be the case that On-Call employees are notified of same day shifts available in the event of an unexpected absence. On-Call employees are not guaranteed work shifts, and the existence and frequency of on-call utilization is strictly subject to the shift coverage needs of Emerge. On-Call employees are expected to work a minimum of one (1) shift per week. Please indicate which days & shifts you would be available to work below.*Hold the CTRL/CMD key to select multiple items.Sun 7:30am-4:00pmSun 3:00pm-11:30pmSun 10:00pm-8:00amMon 7:30am-4:00pmMon 3:00pm-11:30pmMon 10:00pm-8:00amTues 7:30am-4:00pmTues 3:00pm-11:30pmTues 10:00pm-8:00amWed 7:30am-4:00pmWed 3:00pm-11:30pmWed 10:00pm-8:00amThurs 7:30am-4:00pmThurs 3:00pm-11:30pmThurs 10:00pm-8:00amFri 7:30am-4:00pmFri 3:00pm-11:30pmFri 10:00pm-8:00amSat 7:30am-4:00pmSat 3:00pm-11:30pmSat 10:00pm-8:00amI need to give notice to my current employer* Yes No How much notice do they request?* I could be available to start on* How did you learn about our agency and/or positions?* Recruiting/jobing.com Indeed UA ASU Pima Community College Emerge Website Employee Referral Name of Employee* Have you previously applied for a job at Emerge?* Yes No If yes, please state the date of your last applications* Have you previously been employed by Emerge?* Yes No If yes, please state what date you were employed* The position you are applying for may require you to work hours in addition to the schedule posted. Are you able to work hours in addition to the posted schedule?* Yes No If no, please explain*Have you ever been disciplined for violating company rules or regulations?* Yes No If yes, please explain*Use the space below to describe why you are interested in working for our agency.*Work HistoryYour Resume is Not a Substitute for Completing the Following (except where noted). Our employment verification procedure is to contact current/previous employers to verify work history. We request you provide contact information for employers noted on the application/resume. We understand applicants may not have notified their current employer of their job search. We will request the applicant’s permission to contact the current employer if we determine their information would be helpful.Employer OneYour current or most recent employer Employer infoDates Employed (mm/yy-mm/yy)City, StatePhone NumberMay we contact now as an employment verification?Your Supervisor's Name & TitleIndustry/Business TypeYour TitleAverage Hours Worked/WeekWhat did you do in this job?(If your resume specifies this information, please attach it at the end of this form and you may leave this portion blank.)Reason for Leaving Currently Employed? Yes No Employer TwoYour Previous Employer Dates Employed (mm/yy-mm/yy)City, StatePhone NumberMay we contact now as an employment verification?Your Supervisor's Name & TitleIndustry/Business TypeYour TitleAverage Hours Worked/WeekWhat did you do in this job?(If your resume specifies this information, please attach it at the end of this form and you may leave this portion blank.)Reason for Leaving Would you like to list a third employer? Yes No Employer ThreeYour Previous Employer Dates Employed (mm/yy-mm/yy)City, StatePhone NumberMay we contact now as an employment verification?Your Supervisor's Name & TitleIndustry/Business TypeYour TitleAverage Hours Worked/WeekWhat did you do in this job?(If your resume specifies this information, please attach it at the end of this form and you may leave this portion blank.)Reason for Leaving Which of these jobs did you like the best?* What did you like the most about this job?*EducationDo you have a high school diploma or GED?* Yes No Higher degrees you may have earned*Associate/Bachelor/Master/PhDDid you Graduate?Name of SchoolProgram or Area Studied, Degree Major/Minor Other Professional Education you may have completed(which is relevant to the position you are applying for)Name of SchoolProgram or Area StudiedDiploma or Certificate Earned Volunteer ExperiencePlease list any relevant volunteer experience. Please do not list experience which may be protected by City, State or Federal laws/regulations.Name of Agency/GroupDatesTypes of Tasks/DutiesName of Volunteer Administrator/ManagerPhone Number Please list skills/certifications/licenses you have which are pertinent to the position for which you are applying: To provide the highest level of services for our clients, Emerge ensures we have employees who are fluent in Spanish. On occasion, we may also have clients who need assistance in other languages. Please respond to the question below to help us understand what languages in which you’re fluent. (These skills will be assessed during the hiring process) If the position you are applying for does not require you to be bilingual (English / Spanish), your responses to these questions will not disqualify you. Are you fluent (read, writing, speak) in a language other than English?* Yes No Please list the language(s) and describe your level of ability for each.*Please provide a personal statement in this space outlining how your work and life experience directly prepare you to meet the required qualifications listed on the job posting for the position for which you are applying. Please note: it is not requested or necessary to give details of personal experiences; please focus on how your experiences prepare you for the role you are applying for.*Please submit your answers for the following questionsEmerge is building a foundation for an organizational culture that is rooted in a shared understanding of key values that we believe are most important in implementing our work to be in service to survivors in our community. These values are (1) love, (2) safety, (3) joy, (4) innovation, (5) responsibility and repair, and (6) liberation. Please select two of these values and, briefly discuss how you define each of the values you selected and how you see each value being an important part of the culture at Emerge and how that value is tied to our work to address domestic abuse in our community. (250 words maximum)* Please discuss the type of behaviors and/or practices you would bring to Emerge that would uphold the two values you selected. Please include your thoughts about when it might be difficult or challenging for you to personally practice being in alignment with the values you selected. (250 words maximum)*Please read the article (link below) on microaggressions in the workplace and please share the following, in 250 words or less: The article discusses the various impacts of microaggressions in the workplace among coworkers. Please provide an example of a time you observed someone use a micro-aggression with another person and how you addressed it.*To access the article, please copy and paste the following link into your browser's search bar: https://www.bbc.com/worklife/article/20180406-the-tiny-ways-youre-offensive---and-you-dont-even-know-itSignature*I certify that information provided in this application is true and correct to the best of my knowledge. I understand that if I am employed, any false, misleading or otherwise incorrect statements made on this application form or during any interviews may be grounds for termination. I hereby authorize Emerge to contact any company or individual it deems appropriate to confirm my employment history, character and qualifications and I give my full and complete consent to their revealing any and all information they wish as a result of this process and follow-up. In addition, I hereby waive my right to bring any cause of action against these individuals for defamation, invasion of privacy or any other reason because of their statements. If employed, I agree to abide by the policies and procedures of Emerge I also understand that my employment is “at-will” and may be terminated by myself or by the agency at any time for any reason or no reason at all, with or without prior notice. I further understand that only the CEO has the authority to make any agreement contrary to “at-will”.Date* MM slash DD slash YYYY Upload ResumeMax. file size: 512 MB. Personal InformationThis information will be kept confidential and separate from your completed application.Name* First Middle Last Main Contact #*Alternate Contact #Email* Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you 18 years of age or older?* Yes No Do you have the legal right to be employed in the U.S.?* Yes No Have you ever been convicted of any crime (excluding minor traffic violations), including driving while under the influence of alcohol or drugs?* Yes No If yes, please explain:* Do you have a valid Driver’s License?*Most positions at Emerge require driving on agency business, at some point in time, either in an agency vehicle or a personal vehicle (mileage reimbursed). Proof of current insurance will be required upon employment. Yes No Do you have any restrictions on your license which would prevent you from driving an agency vehicle or on agency business?* Yes No If yes, please explain:* Do you have a current fingerprint card?* Yes No Do you have a current CPR card?* Yes No Are you aware of any restrictions you may have on a current fingerprint card OR would be implemented when an application is submitted for fingerprint clearance?* Yes No NameThis field is for validation purposes and should be left unchanged.
