Step 1 of 4 25% Applicant DetailsFirst Name*Last Name*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* SSN*Driver's License Number*Driver's LicensePlease upload a picture of your Driver's License. If you are unable to submit now, you will be asked to email to firstname.lastname@example.org.Are you 18 years of age or older?*YesNoAre you either a US citizen or an alien authorized to work in the US?*YesNoHave you ever worked or attended school under another name? If so, under what name? Position DetailsDesired Position*Start Date* Date Format: MM slash DD slash YYYY Wage Rate Desired*Rate*HourlyWeeklyMonthlyAnnuallyDo you prefer:*Full-time or Part-timeFull-timePart-timeHours you're available to work weekly:*Days of the week you're available:*Are you able to work: Weekends Holidays Nights Overtime Have you previously worked for Habitat for Humanity of Broward or any other affiliate?*YesNoDate of Employment - Start* Date Format: MM slash DD slash YYYY Date of Employment - End* Date Format: MM slash DD slash YYYY Reason for Leaving*Former Supervisor(s)*How did you hear about this job opening?*EducationHighest Level of Education*High SchoolTechnical SchoolCollege/UniversityPost-GraduateHigh School Name*Did you graduate?*YesNoTechnical School Name*Did you graduate?*YesNoCourse of Study*College/University School Name*Did you graduate?*YesNoCourse of Study*Post-Graduate School Name*Did you graduate?*YesNoCourse of Study*Other education, training or special skills:Were you in the U.S. Armed Forces?*NoYesWhat branch?*Date of Duty - Start* Date Format: MM slash DD slash YYYY Date of Duty - End* Date Format: MM slash DD slash YYYY Rank at discharge:*Indicate duties or special training in the service:Please list any additional skills, certifications, or associations to which you belong that pertain to the position for which you are applying.SkillsTyping speed (WPM):Computer Experience*NoneYes, Mac onlyYes, PC onlyYes, both PC & MacWhat programs are you capable of using?Work Experience Please list all previous employment, beginning with the most recent. Required: Employer, Address, Dates Employed, Position Held, Reason for Leaving, Supervisor's Name & Title, Description of Duties, Starting & Ending Compensation. Please note if you do not want us to contact them!Please list the above items, separated by commas.*References Identify three persons who know your work, beginning with the most recent.#1 Name, Phone, Email, Address, Position/Title, Year Known*#2 Name, Phone, Email, Address, Position/Title, Year Known*#3 Name, Phone, Email, Address, Position/Title, Year Known*RésuméPlease upload your résumé. If you are unable to submit now, you will be asked to email to email@example.com. Authorization and Acknowledgements I affirm that the information I have provided in this application is true to the best of my knowledge, information and belief, and I have not knowingly withheld any information requested. I understand that withholding or misstating any information requested in this application is grounds for rejection of my application, and that providing false or misleading information in this application is grounds for discharge. I freely and voluntarily agree to submit to a drug test at any time as may be allowed by state or federal law as part of my application for employment and that any offer of employment is conditional upon passing said pre-employment testing. I also understand and agree that Habitat for Humanity of Broward and Fortune Business Solutions reserves the right to require me to submit to an alcohol test and/or medical examination to the extent permitted by law. I further understand that refusal to submit to said drug and/or alcohol testing as are permitted by law, or the positive testing for prohibited drugs and/or alcohol in accordance with standards established by either state or federal law, may result in disciplinary action, including immediate suspension or termination of employment. Further, I understand that you may be requesting information from various federal, state, or other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil and other experiences. I understand and agree that if hired, I have the right to resign my employment at any time, with or without cause and that my employment may be terminated with or without cause or notice. I understand that this acknowledgement supersedes any prior oral or written understanding. I understand that Habitat for Humanity of Broward and Fortune Business Solutions employer may contact my previous employers, unless otherwise stated, and I authorize employers to disclose all records and other information pertinent to my employment and release them from liabilities that may result from such disclosure. I authorize, without reservation, any party or agency contacted by this employer to furnish the above--mentioned information.Digital Signature* I agree INFORMED CONSENT AND RELEASE OF LIABILITY I understand that in connection with my application for employment and, if hired, during my employment, a consumer report may be requested for employment purposes. All inquiries will be handled in compliance with applicable law including provisions of the Fair Credit Reporting Act, 15 U.S.C. Section 1681, et seq. I understand that the employment decision and my continued employment will be subject to the results of these inquiries. The report may include, but is not limited to, the following areas: Verification of social security number; current/previous residences; employment history; education including transcripts; character references; credit history and reports when applicable; criminal records from any criminal justice agency in any/all federal, state, county, jurisdictions; motor vehicle records; and any other public records or to conduct interviews with third parties relative to my character, general reputation, or personal characteristics. I hereby waive any and all written notice of disclosure that may be required by applicable local, state, or federal laws of my past and/or present employer(s), individuals, or institutions. In exchange for the consideration of my employment application by Fortune Business Solutions, I hereby release and forever discharge, without reservation, Fortune Business Solutions (including its directors, officers, employees, its agents, contractors, and subcontractors) and my past and/or present employers (their directors, officers, employees, and agents) from any liabilities that may result from an investigation of my past and/or present employment or from the disclosure of any information. I further acknowledge that a telephone facsimile (FAX) or photographic copy of this document will be valid as original. THIS INFORMED CONSENT AND RELEASE PROVIDES THAT YOU KNOWINGLY AND VOLUNTARILY AGREE TO RELEASE CERTAIN PERSONAL RIGHTS. IT MAY BE ADVISABLE FOR YOU TO SEEK LEGAL COUNSEL PRIOR TO ENTERING INTO THIS AGREEMENT. Digital Signature* I agree This iframe contains the logic required to handle Ajax powered Gravity Forms.