Red Cross of Rochester

Employment Application

Fields marked with an asterisk(*) are required.

General Information

Last Name: *

First Name: * MI:

Address1: *

Address2:

City: *

State: * Zip: *

Phone(Home): *

Phone(Cell):

Email:

Have you previously been employed with the American Red Cross, Greater Rochester Chapter? *

Yes

No

Employment Desired

Position(s) applied for (Must specify current open position): *

Date available to start: *

Salary Desired: *

How did you hear about this position and the American Red Cross?

Will Consider:

Full Time

Part Time

Per Diem

Education / Training

High School:

Name and Location: *

Course of Study:

Did you graduate?

Yes

No

List diploma or degree:

College(s):

Name and Location:

Course of Study:

Did you graduate?

Yes

No

List diploma or degree:

College 2:

Name and Location:

Course of Study:

Did you graduate?

Yes

No

List diploma or degree:

College 3:

Name and Location:

Course of Study:

Did you graduate?

Yes

No

List diploma or degree:

Graduate School:

Name and Location:

Course of Study:

Did you graduate?

Yes

No

List diploma or degree:

Business / Vocational School:

Name and Location:

Course of Study:

Did you graduate?

Yes

No

List diploma or degree:

Other:

Name and Location:

Course of Study:

Did you graduate?

Yes

No

List diploma or degree:

What languages, other than English, do you speak or write fluently? (Answer is optional)

Employment Experience
List all employment, including military experience. Please start with present or most recent position.

1.	Employer Name:		Phone (With area code):

	Address1:		Address2:

	City:	State Zip:

	Dates Employed: From		To:

	Job Title(s):

	Job Duties:

	Reason for leaving:		Ending Salary:

2.	Employer Name:		Phone (With area code):

	Address1:		Address2:

	City:	State Zip:

	Dates Employed: From		To:

	Job Title(s):

	Job Duties:

	Reason for leaving:		Ending Salary:

3.	Employer Name:		Phone (With area code):

	Address1:		Address2:

	City:	State Zip:

	Dates Employed: From		To:

	Job Title(s):

	Job Duties:

	Reason for leaving:		Ending Salary:

4.	Employer Name:		Phone (With area code):

	Address1:		Address2:

	City:	State Zip:

	Dates Employed: From		To:

	Job Title(s):

	Job Duties:

	Reason for leaving:		Ending Salary:

Have you ever been convicted of a crime? *

Yes

No

If yes, please describe fully in a separate statement, addressed to the Director of Human Resources, the conviction(s) listing the nature of the offense, your age at the time, and your rehabilitation since the conviction(s). Record of convictions will not necessarily disqualify an applicant for employment.

Applicant's Statement
I agree to these terms and conditions.*


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