Regional Consolidated Services

Regional Consolidated Services

"Helping People Help Themselves"
Position Applying For*
Date*

MonthDayYear
Date
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date*

MonthDayYear
Email*
example@example.com
Social Security Number*
Last 4 digits
Phone Number*
Please enter a valid phone number.
Best time to contact you
Have you ever been convicted of a crime?*

YesNo
If yes, please specify: offense, when, where, disposition
Which do you prefer*

Full-TimePart-Time
Date Available to work*
Do you have relatives who work for RCS*

YesNo
If yes, who:
Have you ever worked for RCS?*

YesNo
If yes, when:
Do you have the legal right to work and remain in the United States? Proof of citizenship or immigration status required if employed.*

YesNo
Can you travel if the job requires it?*

YesNo
Do you have a car available to get to work and to use on the job?*

YesNo
Are you willing to accept other than traditional working hours or alter your hours if necessary?*

YesNo
As of now, have you lived in North Carolina for less than five consecutive (in a row) years?*

YesNo
Is there anything that would prevent you from performing, in a reasonable and safe manner, the activities involved in the position for which you have applied?*

YesNo
If yes, explain below:
Education

	Name/Address	Course of Study	Years completed	Diploma/ Certificate/ Degree
High School
Undergraduate
Graduate
Other (specify)

REQUIRED DOCUMENTS

Please attach your most current education document. We will accept a high school diploma/GED, degree, or transcripts. Please make sure you attach the educational document for which you are applying for. For example, if you are applying for Floater, you are only required to upload your high school diploma/GED; however, if you are applying for Lead Teacher, you will need to upload your degree/transcripts for the college you are attending/have attended. Make sure the document is visible.
ONLY UPLOAD EDUCATION DOCUMENTS BELOW*

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Military Service Record
Have you ever served in the U.S. Armed Forces? *

YesNo
If yes, please list duties in the service, including special training that is relevant to the position for which you are applying for.

Work Experience
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations that indicate race, color, religion, gender, national origin, disabilities, or other protected status.
Work Performed: Describe fully the work you performed for this employer.*
Work Performed: Describe fully the work you performed for this employer.*
Work Performed: Describe fully the work you performed for this employer.*
Please explain any gaps in employment.
Skills and Abilities
For example, computer use, computer programs you can operate, typing ability, other office equipment, and other experiences or abilities that you feel qualify you for work with our company.

References:

In listing references, list persons who have knowledge of your qualifications for the position(s) you're applying for. Such as, former co-workers, teachers, etc. Do not repeat names of supervisors you will list under Work Experience.

Please list two Business and two Personal
Personal*
Personal*
Business*
Business*
Resumes and Files:
RCS will not accept a resume in place of information requested on this form. Resumes are accepted as a supplement to the application.

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Training and Certifications

Pre-employment statement: (read carefully before singing below).

I understand and voluntarily agree that:
1. The information I have provided on this application is true and complete to the best of my knowledge. Any misrepresentation or omission of any fact in my application, resume, or any other materials, or during any interviews, can be justification for refusal of employment, or if employed, termination from RCS employment.

2. Any offer of employment I may receive from RCS is contingent upon my successful completion of the total pre-employment screening process including RCS’s receipt of references that it considers satisfactory, and my satisfactory completion of any postjob offer pre-employment physical examination required.

3. I understand that as condition of employment, I may be required to undergo and successfully pass a screening for alcohol and/or drugs. I also understand and agree that, if employed, I may be required to submit to an alcohol or drug screening at any time at the discretion of RCS.

4. In processing my application for employment, RCS may verify all information provided by me concerning, among other things, my prior employment or military record, education, character, general reputation, personal characteristics, criminal record, and mode of living.

5. I authorize and request that all of my present and former employers, and those individuals I have listed as personal references, furnish information about my employment record, including a statement of the reason for the termination of my employment, work performance, abilities, and other qualities pertinent to my qualifications for employment, hereby releasing them from any and all liability for damages arising from furnishing the requested information.

6. In consideration of my employment, I agree to comply with the policies, rules, regulations, and procedures of RCS and understand that my employment and compensation can be terminated with or without cause or notice, at any time, at the option of either RCS or me. No person, other than the RCS Executive Director, has the authority to enter into any agreement with me for employment for any specified period of time or to make any agreement different from or contrary to RCS policy. I further understand that any such agreement, if made, shall not be enforceable unless it is in writing and signed by me and the Executive Director of RCS.
*RCS considers all applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or status as a Vietnam-era or special disabled veteran in accordance with federal laws. RCS complies with applicable state and local laws prohibiting discrimination in employment. We provide reasonable accommodation to individuals with a disability in accordance with applicable laws.
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Date*

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