Racial Justice Fellow Application

It is the policy of Stono Institute for Freedom, Justice and Security to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.

Questions marked by * are required.

Applicant Full Name: *

Home Address:

City/State/Zip:

Number of years at this address:

Email: *

Daytime Phone:

Evening Phone:

Mobile phone:

Social Security Number (last 4 digits):

Driver’s License (State/Number):

Emergency Contact Name: *

Relationship to you: *

Emergency Contact Address: *

Emergency Contact City/State/Zip: *

Emergency Contact Daytime Phone: *

Emergency Contact Evening Phone: *

Salary Desired (list per year or per month):

Who referred you to our company?:

Do you have any friends or relatives who work here? If yes, please list here:

Are you at least 18 years old?: *

How will you get to work?:

Are you willing to work any shift, including nights and weekends?:

If no, please state any limitations:

If applicable, are you available to work overtime?:

If you are offered employment, when would you be available to begin work?: *

If hired, are you able to submit proof that you are legally eligible for
employment in the United States?:

Are you able to perform the essential functions of the job position you seek
with or without reasonable accommodation?:

What reasonable accommodation, if any, would you request?:

APPLICANT’S SKILLS
Check those skills that you have. List any other skills that may be useful for the job you are seeking. Enter the number of years of experience, and circle the number which corresponds to your ability for each particular skill.Enter Years of Experience in each corresponding drop-down list. (1 represents poor ability, while 5 represents exceptional ability.)

Typing:

Microsoft Office Suite (Word, Excel, etc.):

Accounting/Bookkeeping:

Answering Telephones:

Filing:

Customer Service:

Must be able to work in a fast paced environment:

Must be comfortable working in a diverse environment with African-Americans:

Must be culturally competent and contented with racial justice advocacy:

Must be able to type 45 WPM:

Must be faithful, available, and teachable:

Strong verbal and written communication skills:

Strong organizational skills:

Problem solving and decision making:

Must be experienced in managing social media:

Knowledge, Skills and Abilities (KSAs) List KSAs you possess and believe
relevant to the position you seek, such as operating heavy equipment, computer skills, fluency in language(s), etc.:

BACKGROUND INFORMATION

Have you ever been convicted of a felony
or a first degree misdemeanor?: *

If “YES”, what charges?:

Where convicted?:

Date of Conviction:

Have you even pled Nolo Contendere or Pled Guilty to a crime which is a felony
or a first degree misdemeanor?: *

If “YES”, what charges(2)?:

Where convicted(2)?:

Date of Conviction(2):

Have you even had the adjudication of guilt withheld for a crime which is a felony or a first degree misdemeanor?: *

If “YES”, what charges(3)?:

Where convicted(3)?:

Date of Conviction(3):

CITIZENSHIP
The Stono Institute for Freedom, Justice and Security hires only U.S. citizens and lawfully authorized alien workers. You will be required to provide identification and either proof of citizenship or proof of authorization to work in the U.S.

Are you a U.S. citizen?: *

If no, are you lawfully authorized to accept employment with the specific hiring authority to which you are applying?:

EMPLOYMENT HISTORY
List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue on the back page of this application use the add feature. Resumes may be attached to provide additional information.

Employer Name 1:

Supervisor Name 1:

Employer Address 1:

Employer City/State/Zip 1:

Job Duties 1:

Reason for Leaving 1:

Dates of Employment 1 (Month/Year):

Employer Name 2:

Supervisor Name 2:

Employer Address 2:

Employer City/State/Zip 2:

Job Duties 2:

Reason for Leaving 2:

Dates of Employment 2 (Month/Year):

Employer Name 3:

Supervisor Name 3:

Employer Address 3:

Employer City/State/Zip 3:

Job Duties 3:

Reason for Leaving 3:

Dates of Employment 3 (Month/Year):

Employer Name 4:

Supervisor Name 4:

Employer Address 4:

Employer City/State/Zip 4:

Job Duties 4:

Reason for Leaving 4:

Dates of Employment 4 (Month/Year):

EDUCATION & TRAINING

College/University Name and Address:

Did you receive a degree?:

High School/GED Name and Address:

Did you receive a diploma?:

Other Training (graduate, technical, vocational):

Please indicate any current professional licenses or certifications that you hold:

Awards, Honors, Special Achievements:

Military Service: *

Military Branch:

Specialized Training:

Honorably Discharged:

Reference Name 1: *

Reference Address 1: *

Reference City/State/Zip 1: *

Reference Telephone 1: *

Relationship 1: *

Reference Name 2: *

Reference Address 2: *

Reference City/State/Zip 2: *

Reference Telephone 2: *

Relationship 2: *

Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:

Initial: *

Electronic Signature: *

Date: *

Upload your resume: