CYS Employment Application

CYS Employment Application

An Equal Opportunity Employer
Date

MonthDayYear
Date
Position Applying For
Are you bilingual?

YesNo
Name

First NameMiddle NameLast Name
Present Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Permanent Address (if different from present address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone
Please enter a valid phone number.
Home Phone
Please enter a valid phone number.
Email
example@example.com
Applying for:

Regular full-time workRegular part-time workTemporary work, e.g., summer or holiday work
What days and hours are you available for work?
If applying for temporary work, during what period of time will you be available?
Are you available for work on weekends?

YesNo
Would you be available to work overtime, if necessary?

YesNo
If hired, what date can you start work?

MonthDayYear
Date
How did you hear about our company and this job opening?
Have you ever applied to or worked for Comprehensive Youth Services before?

YesNo
Why are you applying for work at Comprehensive Youth Services?
If hired, would you have a reliable means of transportation to and from work?

YesNo
Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age)

YesNo
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?

YesNo
If no, describe the functions that cannot be performed:
Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform functions. Hire may be subject to passing a medical examination, and to skill and agility tests.)
We may refuse to hire relatives of present employees if doing so could result in actual or potential problems in supervision, security, safety, or morale, or if doing so could create confilcts of interest.
Education, Training and Experience
High School
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Did you graduate?

YesNo
Degree or Diploma
College/University
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Did you graduate?

YesNo
Degree or Diploma
Vocational/Business
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Did you graduate?

YesNo
Degree or Diploma
Health Care Training
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Did you graduate?

YesNo
Degree or Diploma
Answer the following questions if you are applying for a professional position:
Are you licensed/certified for the job applied for?

YesNo
Name of license/certification
Issuing State
License/certification number
Has your license/certification ever been revoked or suspended?

YesNo
If yes, state reason(s), date of revocation or suspension, and date of reinstatement
Employment History

List below all present and past employment starting with your most recent employer (last five years is sufficient). You must complete this section even if attaching a resume.
Name of Employer
Phone Number
Please enter a valid phone number.
Type of Business
Your Supervisor's Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dates of Employment
Your Position and Duties
Reason for Leaving
Current Employer?

YesNo
May we contact this employer for reference?

YesNo
Name of Employer
Phone Number
Please enter a valid phone number.
Type of Business
Your Supervisor's Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dates of Employment
Your Position and Duties
Reason for Leaving
May we contact this employer for a reference?

YesNo
Name of Employer
Phone Number
Please enter a valid phone number.
Type of Business
Your Supervisor's Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dates of Employment
Your Position and Duties
Reason for Leaving
May we contact this employer for a reference?

YesNo
Name of Employer
Phone Number
Please enter a valid phone number.
Type of Business
Your Supervisor's Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dates of Employment
Your Position and Duties
Reason for Leaving
May we contact this employer for a reference?

YesNo
Name of Employer
Phone Number
Please enter a valid phone number.
Type of Business
Your Supervisor's Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Employment
Your Position and Duties
Reason for Leaving
May we contact this employer for a reference?

YesNo
References

List below three persons not related to you who have knowledge of your work performance within the last three years.
Name

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Number of years acquainted
Name

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Number of years acquainted
Name

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Number of years acquainted
Please Read Carefully, Initial Each Paragraph and Sign Below
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. Initial Below:*
I hereby authorize Comprehensive Youth Services to thoroughly investigate my references, work record, education and other matters related to my suitability for employment unless otherwise specified above. I further, authorize the references I have listed to disclose to the company any 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 Company, 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. Initial Below:*
I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the Company. 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 any time, with or without prior notice, at the option of either myself or the Company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the Company's designated representative. Initial Below:*
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. Initial Below:*
Date

MonthDayYear
Date
Applicant's Signature

Clear
Should a search of public records be conducted by internal personnel employed by the Company, I am entitled to copies of any such public records obtained by the Company unless I mark the check box below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the box below. “Public records” are defined by California state law and means records documenting an “arrest, indictment, conviction, civil judicial action, tax lien, or outstanding judgment.” (Civil Code section 1786.53) Any public records request performed by internal personnel employed by the Company will only be conducted and used to the extent allowed by federal, state or local law. Initial Below:*
I waive receipt of a copy of any public record described in the paragraph above.

YesNo
Date

MonthDayYear
Date
Applicant's Signature

Clear
Comprehensive Youth Services of Fresno, Inc. (“CYS”) will not conduct a criminal conviction background check, or ask an applicant to disclose, orally or in writing, information concerning their conviction history until CYS makes a conditional job offer.
Should be Empty:

CYS Employment Application

Education, Training and Experience

Answer the following questions if you are applying for a professional position:

Employment History

References

Please Read Carefully, Initial Each Paragraph and Sign Below