APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT
It is our policy to deal with all applicants and employees without regards to race, color, religion, sex, national orgin, marital status, age, disability or status community as a Vietnam era or qualified disabled veteran. Community Aciton Region VI is an equal opportunity employer. Please inform the Human Resources Manager if you require an accommodation in order to particiapte in the application process.

IMPORTANT NOTICE: This is a very significant document. Be very careful as you complete it. Answer each item accuratley and completely. Failure to do so may result in not being considered for the position or in termination, if inaccurate or omitted information is discovered after employment has begun.
Your Initials *
Date *

Month Day Year
Date
PERSONAL INFORMATION
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Please enter a valid phone number.
Email
example@example.com
Are you 18 years of age or older? *

Yes No
Can you provide proof of authorization to work in the U.S.A. *

Yes No
Do you have a valid Driver's License? *

Yes No
Please provide the below information if applying for a position that will require the use of a motor vehicle:
Drivers License Number
State
Exp

EDUCATION
HIGH SCHOOL *
Name and Location of High School. If no High School, enter NONE.
Did you graduate? *

Yes No
COLLEGE *
Name and Location of College. If no College, enter NONE.
Did you graduate? *

Yes No
Major/Minor areas of Study *

PROFESSIONAL REFERENCES

Please list three professional references (individuals who have worked with you and are able to comment on your performance, skills and abilities).
Reference #1

First Name Last Name
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Occupation
Reference #2

First Name Last Name
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Occupation
Reference #3

First Name Last Name
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

City State

Zip Code
Email
example@example.com
Occupation

We require that you read the information below. Your application will not be considered if the signature has been omitted. Furthermore, a photographic copy of this application will be considered the equivalent of the original and can be used as such.

Please read carefully, initial each paragraph and sign below:
The application requests certain information to help CAP evaluate your qualifications. Please provide us with any additional relevant information you would like us to consider. CAP does investigate the background of applicants as well as previous employment experiences, including driving and fingerprint records, if appropriate to the position for which you are being considered. Unless you specifically list any limitation below, you are agreeing to permit us to investigate your background. You are also agreeing to release any persons providing information to CAP from any liability claim or damages as a result of furnishing such information. Please list any limitations you wish and initial below: *
Initial Here
To the best of my knowledge, I declare that all responses in this application are true and complete. I agree that any purposeful untruth, misleading answer, omission, concealment or failure to answer any question completely and accurately may be grounds for not hiring me or for terminating my employment, if I am hired, regardless of the time elapsed before discovery. *
Initial Here
I understand CAP is an at-will employer, and, if I am offered employment and I accept it, my employment is not confined to a fixed term and may be ended by either CAP or myself without prior notice, as per agency policies. I further understand that nothing contained in the application or conveyed during any interview which may be granted or during employment, if hired, is intended to create an employment contract between me and the agency. In addition, I understand and agree that, if I am employed, my employment is for no definite or determinable period and may be terminated at anytime, with or without prior notice, at the option of either myself or the agency, and that no promises or representations contrary to the foregoing are binding on the agency unless made in writing and signed by the Executive Director of Community Action Region VI. *
Initial Here
I authorized CAP or CAP's agents to thoroughly investigate my references, work record, education, and other matters related to my suitability for employment and, further authorize the references I have listed to disclose to the agency and and all letters, reports, and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the agency, my former employers, and all other persons, corporations, partnerships, and associations from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure. *
Indicate your understanding and agreement to these terms signing in the space provided. Thank you for your application. *

First Name Last Name
Date *

Month Day Year
Date
Should be Empty:

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APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION

EMPLOYMENT DESIRED

EDUCATION

MISCELLANEOUS JOB-RELATED INFORMATION

PROFESSIONAL REFERENCES

FORMER EMPLOYERS