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PERSONAL AND CONFIDENTIAL Please attach a recent photograph of yourself |
Application |
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L'ARCHE MOBILE 151-A SOUTH ANN STREET MOBILE, ALABAMA 36604 TELEPHONE: (251) 438-2094 APPLICATION FOR POSITION OF ASSISTANT DATE OF APPLICATION: ___________________ 1. NAME: __________________________________ DATE OF BIRTH: __________________________ STREET: __________________________________ PLACE OF BIRTH: _________________________ CITY & STATE: __________________________________________________ ZIP: ________________ PHONE: ____________________ SINGLE: ____ MARRIED: ____ DIVORCED: ____ WIDOW: ____ Do you have any physical/medical problems? Yes___ __No_____ Briefly describe: _______________________________________________________________________ Have you ever been treated for drug or alcohol abuse? Yes______No _____ Have you ever been convicted of a criminal offense? Yes______No _____ Religious Affiliation: __________________ Closest Relative(s): _________________________________ _____________________________________________________________________________________ Referral source: ________________________________________________________________________ 2. Have you applied to another L'Arche Community? Yes _____No _____Where? __________________ 3. Work Experience: Dates Name & Address Type of Employment Immediate Supervisor ____________ __________________________ ___________________ ____________________ ____________ __________________________ ___________________ ____________________ ____________ __________________________ ___________________ ____________________ ____________ __________________________ ___________________ ____________________ ____________ __________________________ ___________________ ____________________ 4. Education: Completed High School? Yes_____ No_____ Other: Dates Name of Institutions City / State Subjects Studied / Degree ____________ __________________________ ___________________ ____________________ ____________ __________________________ ___________________ ____________________ ____________ __________________________ ___________________ ____________________ 5. Please list leisure activities: _____________________________________________________________ 6. Do you have any outstanding indebtedness? Yes_____ No_____ 7. Please give two personal references: Give name, address, phone, fax #, and position: (1)____________________________ _____________________________________________________ Fax#: _________________________ (2)____________________________ _____________________________________________________ Fax#: _________________________ 8. State briefly why you wish to join a L'Arche Community, specifically L'Arche Mobile: ______________________________________________________________________________________ ______________________________________________________________________________________ 9. For how long would you like to live and work at L'Arche Mobile? ______________________________________________________________________________________ When are you available? __________________________________________________________________ 10. Would you be able to visit L'Arche Mobile for a personal interview? Yes_____ No_____ 11. Please ask any questions you may have or make any additional comments in the space that follows: ______________________________________________________________________________________ ______________________________________________________________________________________ 12. Do you drive? Yes_____ No_____ Do you have a valid driver's license? Yes_____ No_____ ______________________________________________________________________________________ ALL OF THE ABOVE INFORMATION IS GIVEN TO THE BEST OF MY KNOWLEDGE. _______________________________________ Signature
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