Community Support Services, Inc. - Application for Employment

03 Education & Experience
Highest Level of Education Completed*

GEDCollegeHigh SchoolGraduateCommunity or Vocational School
Name of School for Highest Level of Education Completed*
Degree Received*
SPECIAL SKILLS, QUALIFICATIONS, AND CONSIDERATIONS: Summarize any special skills and/or qualifications, volunteer activities, or other activities related to the job you are seeking:
Please list any professional licenses or certifications. (enter your information, click the save button and another row will appear to add addition information if needed)
Do you have experience personally or professionally working with people who have intellectual or developmental disabilities?*

YesNo
Briefly describe your professional and/or personal experience working with people who have developmental and intellectual disabilities. If you do not have any experience, please indicate why you are interested in working with people who have developmental and intellectual disabilities. *

04 Employment History

Start with your current or most recent job. List your last four (4) jobs in order. DO NOT LEAVE OUT ANY JOB.
Employer #1 (most recent)*
Enter the company name
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Start Date*

MonthDayYear
End Date*

MonthDayYear
Job Title*
May we contact this employer?*

YesNo
Supervisor Name & Title*
Number of hours worked per week*
Please describe your duties and responsibilities.*
Reason for leaving*

Add Employer #2
Employer #2
Enter the company name
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Start Date

MonthDayYear
End Date

MonthDayYear
Job Title
May we contact this employer?

YesNo
Supervisor Name & Title
Number of hours worked per week
Please describe your duties and responsibilities.
Reason for leaving

Add Employer #3
Employer #3
Enter the company name
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Start Date

MonthDayYear
End Date

MonthDayYear
Job Title
May we contact this employer?

YesNo
Supervisor Name & Title
Number of hours worked per week
Please describe your duties and responsibilities.
Reason for leaving

Add Employer #4
Employer #4
Enter the company name
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Start Date

MonthDayYear
End Date

MonthDayYear
Job Title
May we contact this employer?

YesNo
Supervisor Name & Title
Number of hours worked per week
Please describe your duties and responsibilities.
Reason for leaving

05 References

List three non-relative individuals not otherwise listed who are familiar with your qualifications and actual work history and ability.
Reference #1*

First NameLast Name
Phone Number*
Email
example@example.com
Reference Occupation/Relationship*
Years Known*
Reference #2*

First NameLast Name
Phone Number*
Email
example@example.com
Reference Occupation/Relationship*
Years Known*
Reference #3*

First NameLast Name
Phone Number*
Email
example@example.com
Reference Occupation/Relationship*
Years Known*

06 Applicant Statement
If you would like to included your resume, please drag and drop your file here.

Cancelof
READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE SIGNING THIS APPLICATION. ONLY THOSE APPLICATIONS THAT ARE COMPLETE, SIGNED, AND DATED ARE CONSIDERED PLEASE VALID. IF YOU HAVE ANY QUESTIONS REGARDING THIS STATEMENT, PLEASE ASK BEFORE SIGNING.

I certify that all answers and statements I have made on this application (and resume or other materials) are true and complete without omissions. I understand that any false information will be grounds for refusal to hire or for immediate discharge if I am employed. I authorize, without reservation, any of the persons named in this application, any law enforcement agency, administrator, state agency, institution, insurance company or agent for this organization, information service or service bureau, or employer contacted by Community Support Services, Inc. to give you complete information and records regarding my employment, education, character, motor vehicle operation history, and qualifications.
I understand that a criminal records check WILL be conducted on me.*

YesNo
I further acknowledge that a telephonic facsimile (fax) or photographic copy of documents shall be as valid as the original. This release incudes all federal and state agencies.*

YesNo
I understand that if I am hired, my employment will be on an at-will basis. I recognize that if I am hired, my employment can be terminated at any time, with or without notice, for any reason not prohibited by law *

YesNo
INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED

I have read, understand, and agree with the above.
Signature*

Clear
Date*

MonthDayYear
Should be Empty:

Application for Employment

01 Personal Information

02 Position

03 Education & Experience

04 Employment History

05 References

06 Applicant Statement