Online Employment Application

Assembly Team Member

Main job requirements include unloading and loading pallets, assembling boxes and packing boxes with food. Successful applicants must be able to safely lift 50 pounds.
Bethel Community Services Foundation

P.O. Box 2189 • Bethel, AK 99559 • (907) 543-1812
Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accomodation to the application and/or interview process should notify BCSF administration.
Position(s) applied for
Date of Application

MonthDayYear
Date
Name*
First Middle Last
Address

Mailing Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone #*
Social Security #
Candidates under 18 must complete a job permit in order to be eligible for hire.
Have you ever been employed here before?

YesNo
Date available for work

MonthDayYear
Date
Type of employment desired

Full TimePart TimeTemporarySeasonalOther:
Are you able to meet the attendance requirements of the position?

YesNo
Have you been convicted of a crime?*

YesNo
If yes, please explain below:
CONVICTION WILL NOT NECESSARILY BE A BAR TO EMPLOYMENT. EACH INSTANCE WILL BE CONSIDERED IN RELATION TO THE TYPE OF POSITION FORWHICH YOU ARE APPLYING.
Do you have an Alaska Drivers License?

YesNo
Employment History

Provide the following information for your past four (4) employers, assignments or volunteer activities, starting with the most recent. A resume may be used in place of this section.

	Job 1
Date Range (_/_/_) - (_/_/_)
Employer
Telephone
Address
Job Title
Supervisor and Title
Reason for leaving
Hourly Rate/ Salary STARTING $$
Hourly Rate/ Salary FINISHING $$

Job 1 - Summarize the Nature of Work Performed and Job Responsibilities

	Job 2
Date Range (_/_/_) - (_/_/_)
Employer
Telephone
Address
Job Title
Supervisor and Title
Reason for leaving
Hourly Rate/ Salary STARTING $$
Hourly Rate/ Salary FINISHING $$

Job 2 - Summarize the Nature of Work Performed and Job Responsibilities

	Job 3
Date Range (_/_/_) - (_/_/_)
Employer
Telephone
Address
Job Title
Supervisor and Title
Reason for leaving
Hourly Rate/ Salary STARTING $$
Hourly Rate/ Salary FINISHING $$

Job 3 - Summarize the Nature of Work Performed and Job Responsibilities

	Job 4
Date Range (_/_/_) - (_/_/_)
Employer
Telephone
Address
Job Title
Supervisor and Title
Reason for leaving
Hourly Rate/ Salary STARTING $$
Hourly Rate/ Salary FINISHING $$

Job 4 - Summarize the Nature of Work Performed and Job Responsibilities
Skills and Qualifications
Summarize any training, skills, licenses, and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.

Educational Background

	Name and Location	Years Completed	Did you graduate? (Major/Degree)
High School
College
Other

References - Please list two (2) professional and two (2) personal references.

	Name	Telephone	Email	Years Known
1
2
3
4

I UNDERSTAND THAT IF I AM EMPLOYED, ANY MISREPRESENTATION OR MATERIAL OMISSION MADE BY ME ON THIS APPLICATION WILL BE SUFFICIENT CAUSE FOR CANCELLATION OF THIS APPLICATION OR IMMEDIATE DISCHARGE FROM THE EMPLOYER’S SERVICE, WHENEVER IT IS DISCOVERED.

I GIVE THE EMPLOYER THE RIGHT TO CONTACT AND OBTAIN INFORMATION FROM ALL REFERENCES, EMPLOYERS, EDUCATIONAL INSTITUTIONS AND TO OTHERWISE VERIFY THE ACCURACY OF THE INFORMATION CONTAINED IN THIS APPLICATION. I HEREBY RELEASE FROM LIABILITY THE EMPLOYER AND ITS REPRESENTATIVES FROM SEEKING, GATHERING AND USING SUCH INFORMATION AND ALL OTHER PERSONS, CORPORATIONS, OR ORGANIZATIONS FOR FURNISHIGN SUCH INFORMATION.

THE EMPLOYER DOES NOT UNLAWFULLY DISCRIMINATE IN EMPLOYMENT AND NO QUESTION ON THIS APPLICATION IS USED FOR THE PURPOSE OF LIMITING OR EXCUSING ANY APPLI CANT FROM CONSIDERATION FOR EMPLOYMENT ON A BASIS PROHIBITED BY LOCAL, STATE, OR FEDERAL LAW.

THIS APPLICATION IS CURRENT FOR ONLY 60 DAYS. AT THE CONCLUSION OF THIS TIME, IF I HAVE NOT HEARD FROM THE EMPLOYER AND STILL WISH TO BE CONSIDERED FOR EM PLOYMENT, IT WILL BE NECESSARY TO FILL OUT A NEW APPLICATION.

IF I AM HIRED, I UNDERSTAND THAT I AM FREE TO RESIGN AT ANY TIME WITH OR WITHOUT CAUSE AND WITHOUT PRIOR NOTICE AND THE EMPLOYER RESERVES THE SAME RIGHT TO TERMINATE MY EMPLOYMENT AT ANY TIME WITH OR WITHOUT CAUSE AND WITHOUT PRIOR NOTICE. EXCEPT AS MAY BE REQUIRED BY LAW. THIS APPLICATION DOES NOT CONSTITUTE AN AGREEMENT OR CONTRACT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OR DEFINITE DURATION. I UNDERSTAND THAT NO REPRESENTATIVE OF THE EMPLOYER OTHER THAN AN AUTHORIZED OFFICER HAS THE AUTHORITY TO MAKE ANY ASSURANCES TO THE CONTRARY. I FURTHER UNDERSTAND THAT ANY SUCH ASSURANCES MUST BE IN WRITING AND SIGNED BY AN AUTHORIZED OFFICER.

I UNDERSTAND THAT IT IS THIS COMPANY’S POLICY NOT TO REFUSE TO HIRE A QUALIFIED INDIVIDUAL WITH A DISABILITY BECAUSE OF THAT PERSON’S NEED FOR A REASONABLE ACCOMODATION AS REQUIRED BY THE ADA.

I ALSO UNDERSTAND THAT IF I AM HIRED, I WILL BE REQUIRED TO PROVIDE PROOF OF IDENTITY AND LEGAL WORK AUTHORIZATION.
To protect the region we love, BCSF requires all employees to be fully vaccinated for COVID-19. This includes receiving the booster. Are you fully vaccinated?*

Yes, I have received two vaccines and one booster for COVID-19.No, I have not received two vaccines and one booster for COVID-19.
If you answered No to the question above, please indicate if you would like to request an Exemption as an accommodation.

YesNo
I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.
Electronic Signature of Applicant: *
By typing your name in this box, you certify that the content of this application is true and correct to the best of your knowledge.
Date*

MonthDayYear
Date
Resume Upload (Optional)

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Assembly Team Member

Bethel Community Services Foundation

Employment History

Skills and Qualifications