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Bartlett House, Inc.
1110 University Ave.
Morgantown, WV 26505
Phone 304-292-0101
Fax 304-292-0031

Looking for a job? Want to help people? Fill out an application and help us end homelessness!
Employment Application

Please fill out the following form or click here to download a printable version and send it via mail or e-mail. Fill in all fields that apply.

Last Name:

First Name:

M.I.:

Street Address:

Apartment/Unit #:

City:

State:

Zip:

Phone Number:

E-mail:

Date Available:

Social Security #:

Desired Salary:

Position Applied for:

Are you a citizen of the United States?
Yes No

If no, are you authorized to work in the U.S.?
Yes No

Have you ever worked for this company?
Yes No

If so, when?

Have you ever been convicted of a felony?
Yes No

If yes, explain

References
Please list three professional references
Full Name:	Relationship:
Company:	Phone (Please provide area code):
Address:
Full Name:	Relationship:
Company:	Phone (Please provide area code):
Address:
Full Name:	Relationship:
Company:	Phone (Please provide area code):
Address:

Previous Employment
Company:	Phone (Please provide area code):
Address:		Supervisor:
Job Title:	Starting Salary:	Ending Salary:
Responsibilities:
From To	Reason for leaving:
May we contact your previous supervisor for a reference? Yes No
Company:	Phone (Please provide area code):
Address:		Supervisor:
Job Title:	Starting Salary:	Ending Salary:
Responsibilities:
From To	Reason for leaving:
May we contact your previous supervisor for a reference? Yes No
Company:	Phone (Please provide area code):
Address:		Supervisor:
Job Title:	Starting Salary:	Ending Salary:
Responsibilities:
From To	Reason for leaving:
May we contact your previous supervisor for a reference? Yes No

Military Service
Branch:	From To
Rank at Discharge:	Type of Discharge:
If other than honorable, explain: