ACDS Job Application New

AVOYELLES HEAD START & EARLY HEAD START EMPLOYMENT APPLICATION

Please complete the entire application to be considered for employment.

Employer: Avoyelles Child Development Services, Inc. Address: P.O. Box 153, Moreauville, LA 71355 Phone: 318-985-2154

It is the policy of Avoyelles Child Development Services, Inc. to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, age, sexual orientation, or disability.

Applicant Information:
Applicant Full Legal Name
Address

Home Address

Street Address Line 2

City/State/ZIPState / Province

Postal / Zip Code
Phone #
Social Security #
Driver's License #
3.Job Position Applied For
Are you at least 18 years old?

YesNo
5. If offered employment when would you be available to begin work?
If hired, are you willing to submit proof that you are legally eligible for employment in the United States?

YesNo
7. Have you ever been convicted of a crime?

YesNO
Are you willing to undergo a Criminal Background Check?

YesNo
Are you able to perform the essential functions of the job position you are seeking with or without reasonable accommodation?

YesNo
What reasonable accommodation, if any, would you request?
9. Applicant's Skills: List Skills:
List Skills
10.Applicant Employment History: (List most recent to previous)
1. Employer Name
Address

Address

Street Address Line 2

City/State/ZIPState / Province

Postal / Zip Code
Job Duties
Reason for Leaving
Dates of Employment

MonthDayYear
Date
2. Employer Name
Address

Address

Street Address Line 2

City/State/ZIPState / Province

Postal / Zip Code
Job Duties
Reason for Leaving
Dates of Employment

MonthDayYear
Date
2. Employer Name
Address

Address

Street Address Line 2

City/State/ZIPState / Province

Postal / Zip Code
Job Duties
Reason for Leaving
Dates of Employment

MonthDayYear
Date
11. Applicant's Education and Training:

College/University/Technical School - Name and Address
Name and Address
Did you receive a degree?

YesNo
If yes, degree received
In what field
High School or GED: Did you receive a diploma?
Did you receive a diploma?

YesNo
Other Training (technical, vocational)
Please list any professional licenses or certifications that you hold.
List any three (3) Non-Related persons who would be willing to provide a reference for you.
(1) Name
Address

Address

Street Address Line 2

City/State/ZIPState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Relationship
(2) Name
Address

Address

Street Address Line 2

City/State/ZIPState / Province

Postal / Zip Code
Telephone
Relationship
Name
Address

Address

Street Address Line 2

City/State/ZIPState / Province

Postal / Zip Code
Telephone
Relationship
Are you directly related to any Avoyelles Child Development Services, Inc. Board Member?

Noif yes name of board
I certify that the information provided on this application is truthful and accurate. I understand that proving false or misleading information will be the basis for rejection of my application, or if employed I would be immediately terminated. I authorize Avoyelles Child Development Services, Inc. to contact former employers and educational organizations to communicate information fully and freely regarding my previous employment, attendance, and education. If I am hired, I understand that the employment relationship will be "At-Will." In other words, the relationship will be entirely voluntary in nature, and either I or Avoyelles Child Development Services, Inc. will be able to terminate the employment relationship at any time.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION. I UNDERSTAND AND AGREE TO ITS TERMS.
APPLICANT SIGNATURE

Clear
DATE

MonthDayYear
Date
Should be Empty: