Last Name

First Name

M.I.

Address (Street, City, ST, Zip)

Telephone:

Home

Work

Email

What position are you applying for?
—Please choose an option—Assistant Property ManagerLaborerMaintenance Aide (High-rise)Maintenance MechanicProgram SpecialistProperty ManagerPublic Safety OfficerSenior Accountant

What is the minimum hourly pay rate you will accept

Desired Status:
Full-TimePart-TimeTemporarySeasonal

What date are you available to start work?

Are you on layoff and subject to recall?
YesNo

Were you ever employed by the KCK Housing Authority?
YesNo

If yes, give:

Dates:

Position(s) held:

Are you a veteran of the U.S. Military Service?
YesNo

If yes, give:

Dates of Duty

Start:

End:

Branch:

Type of discharge:

Do you type?
YesNo
If yes, what is your speed? (wpm)

Do you take shorthand or speedwriting?
YesNo
If yes, what is your speed? (wpm)

Other office machines which you operate:

Have you been released from prison, convicted of or pled guilty to a felony within the last 7 years, or are currently on parole?
NoYes
If yes, explain in detail

Do you hold any elective or appointed federal, state or local office?
NoYes
If yes, explain in detail

Are you related to anyone currently employed with the Housing Authority?
NoYes
If yes, explain in detail

Educational Record

Elementary

School Name

Check Years Completed
45678

Diploma/Degree

Describe Course(s) of Study

High School

School Name

Check Years Completed
9101112

Diploma/Degree

Describe Course(s) of Study

College/University

School Name

Check Years Completed
1234

Diploma/Degree

Describe Course(s) of Study

Graduate/Professional

School Name

Check Years Completed
1234

Diploma/Degree

Describe Course(s) of Study

Honors and/or Awards Received

What specialized training have you completed?

References

Give names, addresses and telephone numbers of 3 references who are not related to you and are not previous employers:

Reference #1

Name

Address

Telehphone

Years Known

Reference #2

Name

Address

Telehphone

Years Known

Reference #3

Name

Address

Telehphone

Years Known

Drivers License

Drivers License #

State of Issue

Date of Expiration

Employment History

Give details of your last five employers and, where necessary, list other previous positions that will account for your employment record over the past ten years. List present or most recent positions first and account for all lapses of time. Include details of military service where service specialties or duties are relevant to the job or position you are seeking.

Company 1

Company Name/Address/Phone:

Title:

Last Base Rate of Pay:

Employment Start:

Employment End:

Reason for leaving (Be specific: Quit, Layoff, Discharge, etc.):

Type of Business:

Supervisor:

Briefly Describe your Duties:

Company 2

Company Name/Address/Phone:

Title:

Last Base Rate of Pay:

Employment Start:

Employment End:

Reason for leaving (Be specific: Quit, Layoff, Discharge, etc.):

Type of Business:

Supervisor:

Briefly Describe your Duties:

Company 3

Company Name/Address/Phone:

Title:

Last Base Rate of Pay:

Employment Start:

Employment End:

Reason for leaving (Be specific: Quit, Layoff, Discharge, etc.):

Type of Business:

Supervisor:

Briefly Describe your Duties:

Company 4

Company Name/Address/Phone:

Title:

Last Base Rate of Pay:

Employment Start:

Employment End:

Reason for leaving (Be specific: Quit, Layoff, Discharge, etc.):

Type of Business:

Supervisor:

Briefly Describe your Duties:

Company 5

Company Name/Address/Phone:

Title:

Last Base Rate of Pay:

Employment Start:

Employment End:

Reason for leaving (Be specific: Quit, Layoff, Discharge, etc.):

Type of Business:

Supervisor:

Briefly Describe your Duties:

May your present employer be contacted?
YesNo

Why are you interested in seeking employment with Kansas City, Kansas Housing Authority?

What do you consider to be your greatest qualification for the job you are applying for?

Equal Employment Opportunity Survey

The following information is needed to accurately fulfill Federal reporting requirements. This information will be immediately separated from your application and will in no way influence your chances for employment with our organization.

Sex
MaleFemale

Age
Under 1818-2930-3940 and over

Education
Less than High SchoolHigh School Diploma or GEDAA DegreeBA/BS DegreeVocational or Business SchoolCollege (no degree)Other

If you chose "Other", specify

Race/Ethnic Group
American IndianAsianAfrican/AmericanWhiteHispanic

Disability

Are there any special accommodations needed to perform the duties of the position for which you are applying?

YesNo

If yes, list:

Marital Status
SingleMarriedWidowedDivorcedSeparated

Veteran Status
NoYes

How did you learn about this job?
Walk-inHousing Authority EmployeeFriendSchoolWebsiteJob Service CenterNewspaperOther