Job Application

Required fields are marked with an asterisk (*)

Position Applied For:

Date Available:

Salary Desired:

General information

Name (first, middle, last)*

Street Address*

City*

State*

Zipcode*

Phone*

e-mail*

If under 18 years of age, Date of Birth

Do you have any relatives presently working for the Authority? yes no
If yes, whom?  

Do you have any relatives on the Board of Commissioners? yes no
If yes, whom?  

Have you ever been employed by Suffolk Redevelopment and Housing Authority?
yes no
If so, when?  

All positions require a valid drivers license and eligibility for coverage under the Authority’s automobile insurance:

Do you have a valid drivers license? yes no

Have you received any traffic violations in the past 2 years? yes no
If yes, please explain  

Have you ever been in the Armed Services? yes no
If yes, Branch of Service:  
Discharge Date:  

Have you ever been convicted of a felony or a misdemeanor, except a minor traffic violation in the past 7 years? (Note: A conviction will not necessarily disqualify applicant from employment.)
yes no
If yes, please explain  

Education

High school name and location

College name and location

Special Courses

Certifications

Work History

Present & past employers
(Begin with most recent)

Employer 1
company name, address, telephone

dates of employment (start/finish)

job responsibilities

supervisor's name & title

Employer 2
company name, address, telephone

dates of employment (start/finish)

job responsibilities

supervisor's name & title

Employer 3
company name, address, telephone

dates of employment (start/finish)

job responsibilities

supervisor's name & title

State reason and length of inactivity between employers:

May we contact your present employer for a work reference? yes no

To assist us in verifying your prior employment, have you ever worked under another name? yes no
If yes, list name  

Skills/experience

Describe skills and experience which you feel qualify you for the position for which you are applying

Give the name of three (3) reliable persons, other than past employer or relatives, who can furnish information to your ability and character.

Reference 1
Name
Address
Phone

Reference 2
Name
Address
Phone

Reference 3
Name
Address
Phone

I hereby affirm that the information given in this application is true and accurate to the best of my knowledge and belief. I understand that any false statement contained herein will disqualify me for employment consideration with the Suffolk Redevelopment and Housing Authority.
I hereby authorize all my previous employers and persons listed as personal references to furnish any information concerning my personal character, work habits or employment record, and I release all such persons from liability for damages incurred as a result of furnishing such information.
Suffolk Redevelopment and Housing Authority is an equal opportunity employer. Our policy is to consider all applicants for employment based on their qualifications and our current job vacancies. Applicants are considered without regard to race, color, religion, national origin, age or disability.