Inclusion Counselor- Employment Application

APPLICATION FOR EMPLOYMENT

Thank you for seeking a position with Lawrence Family Jewish Community Center. We appreciate the time you are giving this process. It is important that you fully and accurately complete this form yourself. We use background and employment screening to verify information and to check for any omitted information. You must truthfully complete every question on this application in order to be considered.
PERSONAL INFORMATION
Name*

First NameLast Name
Jr./Sr.?
As an adult, have you used another first or last name?*

YesNo
If yes, please list them here:
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
Email*
example@example.com
Do you have reliable transportation to and from our business?*

YesNo
If you are under age 18, can you provide proof of your eligibility to work?*

YesNoNot applicable
If hired, can you provide proof of U.S. citizenship or proof of your legal right to work in the U.S.?*

YesNo
EMPLOYMENT DESIRED
What position are you applying for?*
Part-time, Full-time, or Seasonal?*
Who referred you to us?*
What is your desired pay?*
EDUCATION
High School
Name, City and State of School*
Course of Study*
Total Years of Study*
Type of Degree or Diploma*
College/University
Name, City and State of School
Course of Study
Total Years of Study
Type of Degree or Diploma
Graduate/Professional
Name, City and State of School
Course of Study
Total Years of Study
Type of Degree or Diploma
Other Certifications and Credentials
Do you have any other experience, training, qualifications, or skills which make you suited for this position?
EMPLOYMENT HISTORY
Are you currently employed?*

YesNo
If yes, may we contact your present employer?*

YesNo
Have you ever signed a Confidentiality or Non-Disclosure Agreement with any other organization?*

YesNo
Please list your present and prior employers for the past 10 years, starting with your current or most recent employer. Any periods of unemployment must also be shown. You must complete this section even if you are attaching a resume or have already provided one.
Current (or most recent) Employer*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Start Date*

MonthDayYear
Date
End Date

MonthDayYear
Date
Position and duties*
In detail, why did you leave, or, why are you leaving (if still employed)?*
Verification Contact*

First NameLast Name
Phone Number*

Area CodePhone Number
Previous Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Position and duties
In detail, why did you leave?
Verification Contact

First NameLast Name
Phone Number

Area CodePhone Number
Previous Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Position and duties
In detail, why did you leave?
Verification Contact

First NameLast Name
Phone Number

Area CodePhone Number
Please explain any gaps in employment longer than one month
Please attach resume here (Optional)

Browse Files

Cancelof
Please attach cover letter here (Optional)

Browse Files

Cancelof
Please attach any additional documents here

Browse Files

Cancelof
OTHER
Are you able to perform the essential functions of the job for which you are applying with or without reasonable accommodation?*

YesNo
If no, describe the functions that cannot be performed
If hired, are there any accommodations we would need to provide so that you could perform the essential functions and duties of the position you are applying for?*

YesNo
If yes, please let us know
Please read each statement closely and initial each one, acknowledging your understanding.
Complete and Accurate Information - 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 have personally completed this application. I understand that any omission or misstatement of material fact on this application, or any other 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
At-Will Employment - I understand and agree that if I am hired, my employment will be "at-will", which means that the Organization may terminate the employment relationship at any time, with or without cause and with or without notice. Likewise, the Organization will respect my right to terminate my employment at any time, with or without cause and with or without notice. No promise or representation contrary to the foregoing is binding on the Organization unless made in writing and signed by the Organization's Chief Executive Officer.*
Initial
Testing Authorization - If offered a position with the Organization, I hereby agree to any required physical, psychological, skill, drug screening or medical test as a condition of employment. I will receive a separate authorization from to sign for those purposes.*
Initial
Organization Obligation - I understand and agree that the Organization's acceptance of this job application does not mean that a position for which I am qualified is open (unless specifically posted) or that the Organization has agreed to hire me. I understand that the Organization is under no obligation to hire me as the result of accepting this completed application or my resume.*
Initial
I DECLARE THAT ALL OF MY ANSWERS ARE TRUE, ACCURATE, AND COMPLETE UNDER PENALTY OF PERJURY, AND THAT ANY MIS-REPRESENTATIONS MAY DISQUALIFY ME FROM EMPLOYMENT CONSIDERATION AND/OR MAY BE GROUNDS FOR TERMINATION.
Date*

MonthDayYear
Date
Signature*
Should be Empty:

APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION

EMPLOYMENT DESIRED

EDUCATION

EMPLOYMENT HISTORY

OTHER