EMPLOYMENT APPLICATION

SOUTHWEST HUMAN RESOURCE AGENCY
P.O. BOX 264 - 1527 WHITE AVENUE
HENDERSON, TENNESSEE 38340

Southwest HRA is an Equal Opportunity Employer. We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.
If submitting your application online, contact SWHRA to make sure your application has been received.
Upload Resume

Position

1. Position Applied for
2. Referred By:
 
3. Minimum Accepted Salary:
4. Date of Application:
Applicant Information
Last Name
First Name
Middle Initial
6. Address
Street Address
Zip
City
State
Phone (1)
Mailing Address
Mailing Address
Zip
City
State
Phone (2)
Additional Information

Please list any and all work that you have done for residents of local communities, on a volunteer or paid basis, which may have a relationship to the child development or community assistance programs of Community Services Administration. For example church work as an Elder, Deacon, Sunday School Teacher, Chairman or Committeeman or Field Worker in fund raising activity, civic work including registration, PTA leadership activities, leadership in scout work, experience and preparation for many types of Community Services Administration jobs.   *(one per line separate with a semicolon)

10. Education
School Name and Address
Course of Study
Years Completed
Diploma/Degree
School Name and Address
Course of Study
Years Completed
Diploma/Degree
School Name and Address
Course of Study
Years Completed
Diploma/Degree
School Name and Address
Course of Study
Years Completed
Diploma/Degree
11. Languages
Indicate any foreign languages you can speak, read, and/or write. (* one per line)
  FLUENT GOOD FAIR
SPEAK
READ
WRITE
12. Special Skills
Describe any specialized training, apprenticeship, skills, licenses and/or certificates that may qualify you to fill the position for which you are applying.
13. Additional Information
State any additional information you feel may be helpful to us in considering your application.
14. Employment History
14a.
Employer
Contact Phone
Address
Starting Job Title/Final Job Title
Immediate Supervisor Name and Title
Reason for Leaving
May we contact for reference?
Dates Employed
From
To
Hourly Rates/Salary
Starting $/PER
Final $/PER
Summarize the type of work performed and job responsibilities.
14b.
Employer
Contact Phone
Address
Starting Job Title/Final Job Title
Immediate Supervisor Name and Title
Reason for Leaving
May we contact for reference?
Dates Employed
From
To
Hourly Rates/Salary
Starting $/PER
Final $/PER
Summarize the type of work performed and job responsibilities.
14c.
Employer
Contact Phone
Address
Starting Job Title/Final Job Title
Immediate Supervisor Name and Title
Reason for Leaving
May we contact for reference?
Dates Employed
From
To
Hourly Rates/Salary
Starting $/PER
Final $/PER
Summarize the type of work performed and job responsibilities.
14d.
Employer
Contact Phone
Address
Starting Job Title/Final Job Title
Immediate Supervisor Name and Title
Reason for Leaving
May we contact for reference?
Dates Employed
From
To
Hourly Rates/Salary
Starting $/PER
Final $/PER
Summarize the type of work performed and job responsibilities.

Comments: Including explanation of any gaps in employment.
References
Give at least four (4) references other than relatives and supervisors. * (one per line)
Name
Address (Street, City, State)
Phone
How long you've known them

I certify the information contained in this application is correct and understand that falsification of this information is grounds for dismissal. I authorize a background and credit investigation if deemed necessary by the Agency. If employed, I understand I will be a probationary employee for six (6) months, plus periods of absence or layoff, during which time the Agency or myself may terminate the employment relationship without prior warning or notice. I further acknowledge that if I am employed by the Agency, my employment is subject to termination with or without cause, at any time, by either me or the Agency. I understand that no representative of the Agency other than the Executive Director has authority to enter into any agreement for employment for any specified period of time. I consent to a physical examination, which may include a drug use screening test, either prior to commencing work, during my probation period, or at any subsequent time as deemed necessary by the Agency. I authorize any of the persons, previous employers or educational institutions named in this application to release to this Agency, to which I am applying for employment, any and all information they might have concerning me, including records of disciplinary action and reasons for termination of employment. I release all such parties from all liability which may result from furnishing such information. A photocopy of this authorization shall be my authorization for release of information.

Applicant's Signature

Where Are We?

Where are we image map...

The Tennessee General Assembly established Southwest Human Resource Agency (SWHRA) in 1973 as one of nine Human Resource Agencies deemed to be the delivery system for human services throughout the state of Tennessee. SWHRA is a public non-profit agency that serves an eight county region including Chester, Decatur, Hardeman, Hardin, Haywood, Henderson, McNairy and Madison counties...

read more