PVP Employment Application

Employment Application

235 W Mission Blvd, Pomona 91766 - Office (909) 326-0482
By completing this application, you understand and accept that you are applying for a position as an "At Will" employee as California is an "At-Will" Employment State. "At Will" employment means that either you or the Business and/or Organization can terminate your employment with or without cause and with or without notice.
CURRENT VACANCIES:
- Youth Engagement Specialist - Full-time
- LMFT/LCSW Supervisor (Consultant)
Position Applying for:*
Date*
Who referred you to apply?
Personal Information
Legal Name*

First NameMiddle NameLast Name
Chosen Name

First NameLast Name
Pronouns*
Availability/Start Date:*
If hired, when would you be able to start working?
Address*

Street Address

Street Address Line 2

CityState / Zip Code

State / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Are you eligible to work in the US?*

YESNO
Have you been convicted of a felony?*

YESNO
Are you bilingual?

YESNO
Are you available for full time work? (40 hrs/week)

YESNO
Please provide scheduling accommodations that would be required should you be offered full-time employment:
PVP is open Mon-Sat 10am-7pm (Employees will be schedule for in-person work 9a-6p or 10a-7p, 5 days a week)
Education

Please provide 3 professional references. Every box must have an answer.*

Acknowledgement & Authorization
Any pertinent information that you believe should be considered for the position for which you are applying:
I certify that all answers in this employment application are true and complete to the best of my knowledge.*

YES
I authorize an investigation of all statements in this employment application as it may be necessary in arriving at an employment decision.*

YES
In the event of an offer of employment, I understand that false or misleading information given in my employment application or interview/s may result in immediate discharge.*

YES
I understand that California is an "At-Will" Employment State. "At Will" employment means that either you or the Company/Organization can terminate your employment with or without cause and with or without notice.*

YESNO
Signature

Clear
Should be Empty:

Employment Application