CAPECO - Employment Application Packet

CAPECO

Employment Application Packet
Thank you for considering the Community Action Program of East Central Oregon (CAPECO) as a prospective employer.

This packet consists of the following:
1. CAPECO Employment Application
2. Equal Employment Opportunity, Voluntary Self-Identification Data Sheet
3. Recruitment Survey
Complete the application.

The application must be fully completed.

A resume will NOT be accepted as a substitute for the application.

Submit your completed application and any additional information.

If you have questions, call the Human Resources office at 541-278-5666.

CAPECO

Mission: Assisting people to become independent, healthy and safe.

Vision: CAPECO envisions the success of every youth, adult and senior to eliminate poverty and promote independence through employment and the sharing of resources that move individuals from surviving to thriving.

Core Values:

Image: We serve our community in a positive, innovative, accountable and fiscally responsible manner in an inviting atmosphere which upholds the public trust and fulfills our mission.

Integrity: A personal commitment to do what is right morally, ethically and professionally.

Attitude: We exhibit positive, respectful, confident and non-judgmental behavior toward others. Our success is a reflection of our attitude.

Customer Service: We aspire to provide our customers with prompt, courteous, consistent and resourceful services. We treat each individual with dignity, fairness and respect. Customer service is not a department, it is an attitude! Our customers are the essence of our existence.

Professionalism: We exemplify the highest standard of professionalism. We aspire to set an example by maintaining a high level of knowledge in our respective fields and conduct ourselves in a manner that reflects positively on the company.

CAPECO Employment Application
Date of Application *

Month Day Year
Name *

First Name Middle Name Last Name
Home Telephone

Area Code Phone Number
Cell or Other Telephone

Area Code Phone Number
Date Available to Begin Work *

Month Day Year
Street Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Are you 18 years of age or older? *

Yes No
Position Applying For *
Have you ever worked for CAPECO before? *

Yes No
EQUAL EMPLOYMENT OPPORTUNITY. It is CAPECO’s policy to seek and employ the best qualified employees, to provide equal opportunity for the advancement of employees and to administer all of our employment policies in a manner that will not discriminate against any person because of race, color, religion, age, sex, sexual orientation, gender identity, marital or veteran status, national origin, mental or physical disability, genetic information, on-the-job injuries, or any other status protected by applicable law.

IMPORTANT: If hired, all employees must (1) have or obtain a social security number for payroll purposes and (2) present document(s) verifying identity and eligibility to work in the United States and complete an I-9 (employment eligibility verification) form.

EMPLOYMENT EXPERIENCE: Start with your most current or recent job first. List all employment, including any self-employment or military service for the last ten years. You can include more if you feel it’s relevant to the position. Attach an additional sheet if you need more space to list employment experience.
Current / Most Recent Employer
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Supervisor *
Hire Date *

Month Day Year
End Date *

Month Day Year
Job Title *
Job Duties *
Reason for Leaving
Additional / Previous Employer
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Supervisor *
Hire Date *

Month Day Year
Date
End Date *

Month Day Year
Date
Job Title *
Job Duties *
Reason for Leaving *
Previous Employer
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Supervisor *
Hire Date *

Month Day Year
Date
End Date *

Month Day Year
Date
Job Title *
Job Duties *
Reason for Leaving *
Prior Employer
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Supervisor *
Hire Date *

Month Day Year
Date
End Date *

Month Day Year
Date
Job Title *
Job Duties *
Reason for Leaving *
Have you ever been terminated, quit because you believed that you might be terminated, or quit at an employer’s request? *

Yes No
If Yes, please identify employer and explain circumstances *

VERIFICATION, AUTHORIZATION AND SIGNATURE
1. I authorize the investigation of all matters that CAPECO deems relevant to my qualifications for employment, including all information given in this application and in any attachments, supporting documents or interviews. I authorize you to request and receive such information, and I release from all liability any current or former employers, other entities (such as schools, etc.), or persons (such as current or former supervisors, coworkers, etc.), supplying it. I also release you from all liability that might result from making the investigation.
2. I certify that all of the information given in this application and in any attachments, supporting documents or interviews is (or will be) true and complete to the best of my knowledge. I understand and agree that any falsification, misrepresentation or omission, as well as any misleading statements or omissions, generally will result in denial of employment, withdrawal of any offer of employment, or immediate termination, regardless of when and how discovered.
3. I understand and agree that I may be required to submit to pre- or post-employment physical or other professional examinations, medical inquiries and/or urinalysis or alternative tests for the presence of drugs and/or alcohol. IMPORTANT: This means that with very few exceptions an employee will be required to submit to testing in several different circumstances. Ask to see copies of our applicant and employee alcohol and drug policies if you have any questions. I agree to such examinations, inquiries and/or testing at CAPECO’s expense. I authorize release of the results to CAPECO and their use to evaluate my suitability for employment. I also release CAPECO from all liability arising out of or connected with any examinations, inquiries and/or testing.
4. I understand and agree that I may resign or be terminated “at-will,” without cause or notice, at any time, unless otherwise stated in a written employment contract. I also understand and agree that Board of Directors and/or the CEO are the only persons who will ever have the authority to agree to any other terms and/or to enter into such contracts, and that all such agreements for other terms of employment or contracts must also be signed by both parties and/or their authorized representatives to be valid. I also understand and agree that unless otherwise stated in a written employment contract, CAPECO may change, withdraw and interpret other policies (including wages, hours and working conditions), except for this policy of employment at-will, as it deems appropriate.
5. This application will only be considered for 45 days. I understand that if I have not been hired within this time period and still want to be considered for employment, I must complete a new application.
6. I understand and agree that if I am hired, the statements in these paragraphs will become a binding part of my employment relationship. I have read (or had read to me in a language I understand) each of these statements. I have also reviewed all of the information provided in this application and in any attachments or supporting documents.
Signature *
Date

Month Day Year
Unsigned or incomplete applications will not be considered.
Space Below for Office Use Only

☐ Accepted	☐ Recruitment closed	☐ Insufficient experience
☐ Not accpeted for	☐ Application incomplete	☐ Lacks licenses
reasons checked	☐ Insufficient education	☐ Other:
to the right

Reviewed by:	________________________________
Review date:	________________________________
Date received:	________________________________
Date postmarked if mailed:	________________________________

RECRUITMENT SURVEY
Please tell us how you learned about this employment opportunity by including below the resource(s) you used. This information is not part of the applicant evaluation procedure and is used by Human Resources to continually monitor the effectiveness of our recruitment efforts.

CAPECO Employee WorkSource Oregon (Employment Department) Newspaper or Publication (please specify below) Referred by (please specify below) Other (please specify below) Facebook Twitter Other social media (please specify below)
Please specify "Other" *
Thank you for participating!
Should be Empty:

	Full Name	Title/Relationship	Company	Phone	Street Address	City, State ZIP
1
2
3

	Language	Understand	Speak	Read	Write
1
2
3