NAZCARE, Inc Employment Application

NAZCARE, Inc Application for Employment

An Equal Opportunity Employer
Employees of NAZCARE and applicants for employment shall be afforded equal opportunity in all aspects of employment without regard to race, color, religion, political affiliation, national origin, disability, marital status, gender or age.

As a means of accommodation to persons with specific disabilities that prevent them from completing this application, confidential assistance in filling out this application may be obtained.
Your Name: *

First Name Last Name
Position Applied for: *
Center (Location): *
Your Cell Phone Number: *
Please include your main phone number here.
Your Home Phone Number:
If you don't have a cellphone include your landline number here.
Your Email Address: *
example@example.com
Your Mailing Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Education:
Highest Grade Completed (Secondary Education): *

1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade
Year Completed: *
If you did not complete high school, do you have a high school equivalency diploma or GED?

Yes No
Select the number of years of post high school education:

1 2 3 4 5 6 7
Date Completed or Graduation Date:

Month Day Year

Institution Information (Address, Hours, Degree Information, Dates Attended):

Do you expect to complete an educational program in the near future, if you do please indicate what type of degree or program and the expected completion date:
Experience and Employment, Volunteering History
10. EXPERIENCE - Use Supplementary Experience Form(s) for additional space.

Starting with the most recent, describe ALL paid, military and applicable voluntary experience. Highlight your knowledge, skills and abilities which best demonstrate your qualifications for this position You may list significantly different jobs within the same organization as separate items
May we contact your present supervisor? *

Yes No
Job #1:

Employment Information (Job #1 - Most Recent): *

	Job Title	Employer Name:	Address:	Phone Number:	Business Type:	Supervisor Name:	Supervisor Title:
Job #1:

Employment Information (Job #1 - Most Recent): *

	Salary Start:	Salary Finish:	Dates (mo/yr):	Dates to (mo/yr):	Part Time	Full Time	Hours/Wk:	Number and titles of employees you supervised:	Equipment Used:	Reason for Leaving:	Your name if different from present:
Job #1:

Duties - Employment Information (Job #1 - Most Recent): *
Type all duties you completed during this period of employment
Job #2:

Employment Information (Job #2):

	Job Title	Employer Name:	Address:	Phone Number:	Business Type:	Supervisor Name:	Supervisor Title:
Job #2:

Employment Information (Job #2):

	Salary Start:	Salary Finish:	Dates (mo/yr):	Dates to (mo/yr):	Part Time	Full Time	Hours/Wk:	Number and titles of employees you supervised:	Equipment Used:	Reason for Leaving:	Your name if different from present:
Job #2:

Employment Information (Job #3):

	Job Title	Employer Name:	Address:	Phone Number:	Business Type:	Supervisor Name:	Supervisor Title:
Job #3:

Employment Information (Job #3):

	Salary Start:	Salary Finish:	Dates (mo/yr):	Dates to (mo/yr):	Part Time	Full Time	Hours/Wk:	Number and titles of employees you supervised:	Equipment Used:	Reason for Leaving:	Your name if different from present:
Job #3:

Employment Information (Job #3) - Duties:
Employment Information - Continued:
Other Employment Info - Use this space for any additional information you think would help us evaluate your application, including training, seminars, workshops, and special achievements or specialized skills:
Please list any foreign languages and/or sign languages that you are fluent in:
WPM (Typing Speed):

Licensing - License (to include driver's), certificate or other authorization to practice a trade or profession:

	Type	License Number	Granted by (licensing board)
License I:
License II:

List names, addresses and relationships of three persons not related to you who know your qualifications:

Acknowledgement:
Acknowledgement:
NOTE: All employment relationships with NAZCARE are of an at-will nature. This means that should you become employed, you may resign at any time, or NAZCARE may terminate you at any time. with or without cause. subject to Federal and State statutory limitations.

14.CERTIFICATION--Each Application Requires Current Date and Original Signature I hereby certify that all entries on both sides and attachments are true and complete, and 1agree and understand that any falsification of information herein, regardless of time of discovery. may cause forfeiture on my part to any employment in the service of the NAZCARE 1 understand that all information on this application is subjectto verification and consent to criminal history background checks. I also consent to references and former employers and educational institutions listed being contacted regarding this application. I further authorize NAZCARE to rely upon and use. as it soes fit. any information received from such contacts. Information contained on this application may be disseminated to other agencies, nongovernmental organizations or systems on a need to know basis for good cause shown as determined by the CEO designee.
Applicant Signature *

Sign with your mouse, finger, or another input device Clear
Date *

Month Day Year
Should be Empty:

NAZCARE, Inc Application for Employment