Application for Employment

READ THESE INSTRUCTIONS CAREFULLY BEFORE FILLING OUT APPLICATION.

Incomplete applications WILL NOT be considered for employment.

"See resume" is not an acceptable answer.

For questions not applicable, put "n/a." For answers not known, put "don't know."

A place to attach a resume is at the end.

Applications for employment of all positions are considered without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or other legally protected status.

FACT, Inc. is an Equal Opportunity Employer/Service Provider. By law, no person can be hired until a criminal background check is completed.

AS A PARTNER WITH THE ARKANSAS DEPARTMENT OF WORKFORCE SERVICES, WE REPORT ALL APPLICANTS WHO FAIL TO KEEP THEIR SCHEDULED INTERVIEW OR FAIL TO REPORT FOR A SET START DATE. ONLY SERIOUS APPLICANTS NEED APPLY.
Position Applying for:
Position Applying for: (select an alternate position or leave blank)
Position Applying for: (select an alternate position or leave blank)
Date of Application

MonthDayYear
Date
Name (last, first, middle initial)
First Name, Last Name

First NameLast Name
Social Security Number
Mailing Address STREET or PO BOX
CITY
STATE
ZIP
Residence Address STREET or PO BOX (if different from mailing address or type "same")
CITY (if different from mailing address or type "same")
STATE (if different from mailing address or type "same")
ZIP (if different from mailing address or type "same")
Home Phone #
Format: (000) 000-0000.
Cell Phone #
Format: (000) 000-0000.
Email
Have you ever filed an application with us before?
If yes, give date:
Have you ever been employed with us before?
If yes, give date:
Are you currently employed?
May we contact your present employer?
Are you currently on "lay-off" status and subject to recall?
Are you prevented from lawfully becoming employed in this country? (proof of authorization to work in the U.S. will be required upon employment)
Can you travel if the job requires it?
Have you been convicted of a felony within the last 7 years? Conviction will not necessarily disqualify an applicant from employment.
If yes, please explain:
What date would you be available for work?

MonthDayYear
Date
Are you available for (select all that apply):
EDUCATION
High School: Select the Highest Grade Completed
High School Name Attended/Graduated From
High School Location (City, State)
College:
Degree Program (if your program is not listed LEAVE BLANK and move to the next question. This and the next questions are the ONLY questions that can be left blank. Complete this one or the other, not both)
If your Degree Program was not listed, please add it here (otherwise LEAVE BLANK. This and the next questions are the ONLY questions that can be left blank. Complete this one or the other, not both)
College Name
College Location (City, State)
College Program of Study/Major. DO NOT list your college name here. Example: Early Childhood Education (answer if you have some college, currently enrolled, or completed)
Number of currently completed semester hours
If you have a Vocational or Technical Degree list it here
Vocational or Technical School Name
Vocational or Technical School Location (City, State)
Vocational or Technical School Major
Vocational or Technical School Hours Completed
Other specialized certificates or degrees held (be specific.)
Other specialized certificates or degrees location (City, State)
Other specialized certificates or degrees majors
Other specialized certificates or degrees hours completed
SPECIALIZED SKILLS

Language questions are for ADDITIONAL languages spoken besides English. Enter the language skills you feel matches you BEST. If you do not feel competent in any additional languages, enter n/a.
I am fluent to speak (type language)*, read (type language)*, and write (type languge)*
I am good at speaking (type language)*, reading (type language)*, and writing (type languge)*
I am fair at speaking (type language)*, reading (type language)*, and writing (type languge)*
Skills and Equipment Operated (check all that apply)
If you checked for Databases, list which one(s):
If you checked for Word Processing, list which one(s):
List Other Skills/Equipment Operated:
PERSONAL REFERENCES

Do not list relatives or former employers. Please list THREE.

If you do not list THREE your application will NOT BE CONSIDERED
Reference 1: First and Last Name
Reference 1: Best Phone Number
Format: (000) 000-0000.
Reference 1: City & State
Reference 1: Occupation
Reference 2: First and Last Name
Reference 2: Best Phone Number
Format: (000) 000-0000.
Reference 2: City & State
Reference 2: Occupation
Reference 3: First and Last Name
Reference 3: Best Phone Number
Format: (000) 000-0000.
Reference 3: City & State
Reference 3: Occupation
Miscellaneous
FACT, Inc. covers an eight county area: Calhoun, Columbia, Dallas, Hempstead, Lafayette, Nevada, Ouachita, and Union. Are you interested in working in a specific county?
If yes, please list the county(ies) you're available to work in. If you only wish to work in a specific city, you can list that city instead. You can list all if available for all:
Are you related to anyone working for FACT, Inc., or on the Board of Director's or Policy Council?(relationship does not disqualify applicant from employment consideration):
If yes, list name and relation:
For statistical information, are you the parent/guardian of a present or former Head Start child?
If yes, please indicate if you're a present or former parent/guardian.
For statistical information, are you a former Head Start student?
How did you hear about us?
If you selected newspaper, which newspaper?
If you selected another agency, which agency?
If you selected other, please list: (facebook ad, tv ad, yard sign, mailings, etc.)
EMPLOYMENT HISTORY

Start with your present or most recent employer.
1: COMPANY
1: Telephone
Format: (000) 000-0000.
1: Full Address- STREET ADDRESS
1: CITY, STATE, ZIP
1: Starting Date (Month/Year: example 01/2015)
1: Ending Date (Month/Year or list Present)
1: Supervisor
1: Job Title
1: Hourly Wage
1: Hours Per Week
1: Duties
1: Reason for Leaving
2: COMPANY
2: Phone
Please enter a valid phone number.Format: (000) 000-0000.
2: Full Address: STREET ADDRESS
2: CITY, STATE, ZIP
2: Starting Date (Month/Year)
2: Ending Date (Month/Year)
2: Supervisor
2: Job Title
2: Hourly Wage
2:Hours Per Week
2: Duties
2: Reason for Leaving
3: COMPANY
3: Telephone
Format: (000) 000-0000.
3: Full Address: STREET ADDRESS
3: CITY, STATE, ZIP
Starting Date (Month/Year)
Ending Date (Month/Year)
Supervisor
Job Title
Hourly Wage
Hours Per Week
Duties
Reason for Leaving
4: COMPANY
4: Telephone
Format: (000) 000-0000.
4: Full Address: STREET ADDRESS
4: CITY, STATE, ZIP
4: Starting Date (Month/Year)
4: Ending Date (Month/Year)
4: Supervisor
4: Job Title
4: Hourly Wage
4: Hours Per Week
4: Duties
4: Reason for Leaving
I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

I hereby understand and acknowledge that any employment relationship with this organization is 'at will', which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this 'at will' employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that incomplete, false, or misleading information given in my application or interview(s) may result in discharge. I understand also, that I am required to abide by all rules and regulations of the employer.

I hereby understand that this application for employment is considered active for a period of time not to exceed six (6) months, at which time it will be destroyed, unless notification of continued interest in employment is given to FACT, Inc.
Please attach a copy of your resume

Cancelof
Signature of Applicant
Date

MonthDayYear
Date
Voluntary Applicant Data Record

Applications for employment of all positions are considered without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or other legally protected status. FACT, Inc. is an Equal Opportunity Employer/Service Provider. By law, no person can be hired until a criminal background check is completed.
Name

First NameLast Name
Sex (check one):
Race (check all that apply):
Are you Spanish/Hispanic/Latino? (check one)
Should be Empty:

EDUCATION

SPECIALIZED SKILLS

Miscellaneous

EMPLOYMENT HISTORY

Voluntary Applicant Data Record