We are an equal opportunity employer

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Ivy Square Realty & Mgmt. Co.

Employment Application

(Please print, fill out and bring with you to scheduled appointment

or Fax to 434-296-6108 )

We are an equal opportunity employer

Position Applied For: _________________________________ Date of Application: _________________

Name: ________________________________________________________________________________________

Last First Middle

Address: ________________________________________________________________________________________

Street City State Zip

Phone: _______________________ Mobile/Fax: ___________________ Soc Sec#: _______________________

Date Available to start: _______________________

Type of Employment desired: Full-Time Part-Time Temporary

If needed are you available to work overtime & or weekend? Yes No

Have you ever been convicted of a crime or felony in the past? Yes No

If yes, please explain: ____________________________________________________________________________

Are you legally eligible for employment in the United States? Yes No

If you are under 18, do you have a work permit? Yes No

What type of transportation do you plan on using for employment? ________________________________________

Work Experience

From To Employer Phone

Job Title Address

Immediate Supervisor and Title Nature of work & responsibilities

_____________________________________________________________________________________________________________________________________________

Reason for leaving Hourly rate/Salary

From To Employer Phone

Job Title Address

Immediate Supervisor and Title Nature of work & responsibilities

_____________________________________________________________________________________________________________________________________________

Reason for leaving Hourly rate/Salary

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From To Employer Phone

Job Title Address

Immediate Supervisor and Title Nature of work & responsibilities

_____________________________________________________________________________________________________________________________________________

Reason for leaving Hourly rate/Salary

References (Does not include Family & Friends): ________________________________________ Phone: _____________________

______________________________ Phone: _______________

Notice of Use of Consumer Reports

As a condition of employment with Ivy Square Realty & Mgmt. Co. a consumer report and/or investigative consumer report may be obtained for employment purposes when evaluating your eligibility for employment, promotion, reassignment, and/or retention.

Consumer Authorization to Obtain Consumer Report

For Employment Purposes

“I hereby authorize Ivy Square Realty & Mgmt. Co. to obtain a consumer report for employment purposes, and any other information it deems necessary, for the purpose of evaluating my application for employment. I understand that such information may include, but is not limited to, credit history, civil and criminal information, records of arrest, rental history, employment or salary details, vehicle records, licensing records, and/or any other necessary information. I hereby expressly release Ivy Square Realty & Mgmt. Co., and any procurer or furnisher of information, from any liability what-so-ever in the use, procurement, or furnishing of such information, and understand that my application information may be provided to various local, state and /or federal government agencies, including without limitation, various law enforcement agencies.”

Authorized Signature: ________________________________________ Date: __________________________