SCACAP Employment Application

SCACAP Employment Application
Name*

First NameMiddle NameLast Name
Date*

MonthDayYear
Date
Street Address*
Apartment/Unit #*
City*
State*
ZIP Code*
Phone*
Email*
example@example.com
Date Available*

MonthDayYear
Date
Desired Salary:$*
Position Applied for*
Professional License information
Driving License # & expiration date

MonthDayYear
Date
Are you a citizen of the United States?*

YesNo
If no, are you authorized to work in the U.S.?*

YesNo
Have you ever worked for this company?*

YesNo
If yes, when?
Have you ever been convicted of a felony in the 7 years?*

YesNo
If yes, explain
Education
1. High School*
Address*
From * To *
Did you graduate?*

YesNo
Diploma
2. College
Address
From To
Did you graduate?

YesNo
Degree
3. Other
Address
References
1. Full Name*
Relationship*
Company*
Phone*
Address*
2. Full Name*
Relationship*
Company*
Phone*
Address*
3. Full Name*
Relationship*
Company*
Phone*
Address*
Previous Employment
Company*
Phone*
Address*
Supervisor*
Job Title*
Starting Salary $*
Ending Salary $*
Responsibilities*
From * To *
Reason for Leaving*
May we contact your previous supervisor for a reference?*

YesNo
Employment
1. Company*
Phone*
Address*
Supervisor*
Job Title*
Starting Salary:$*
Ending Salary:$*
Responsibilities*
From * To *
Reason for Leaving*
May we contact your previous supervisor for a reference?*

YesNo
2. Company*
Phone*
Address*
Supervisor*
Job Title*
Responsibilities*
Starting Salary:$*
Ending Salary:$*
From * To *
Reason for Leaving*
May we contact your previous supervisor for a reference?*

YesNo
Military Service
Branch
From To
Rank at Discharge
Type of Discharge
If other than honorable, explain
Please read carefully before signing.

I understand that neither the completion of this application nor any other part of my consideration for employmentestablishes any obligation for SCACAP to hire me. If I am hired, I understand that either SCACAP or I can terminate myemployment at any time and for any reason, with or without cause and without prior notice. I understand that norepresentative of SCACAP has the authority to make any assurance to the contrary.I attest with my signature below that I have given to SCACAP true and complete information on this application. Norequested information has been concealed. I authorize SCACAP to contact references provided for employment referencechecks. If any information I have provided is untrue, or if I have concealed material information, I understand that this willconstitute cause for the denial of employment or immediate dismissal.
Date

MonthDayYear
Date
Signature*

Clear
THIS APPLICATION IS VALID ONLY FOR 60 DAYS FROM THE DATE ABOVE.
Resume Upload

Cancelof
Should be Empty:

SCACAP Employment Application

Education

References

Previous Employment

Employment

Military Service