CEO Employment Application

COMMISSION ON ECONOMIC OPPORTUNITY
APPLICATION FOR EMPLOYMENT
An Equal Opportunity Employer
We do not discriminate on the basis of race, color, religion, national origin, sex, age, or disability. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors.

Answer each question fully and accurately. No action can be taken on this application until you have answered all questions. Use blank paper if you do not have enough room on this application. PLEASE PRINT, except for signature. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job related information.
Job Applied for*
Today’s Date*

MonthDayYear
Date
Are you seeking*

Full-time employmentPart-time employmentTemporary employment
When could you start work?*

MonthDayYear
Date
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone Number*
Are you 18 years of age or older? (If you are hired, you may be required to submit proof of age.*

YesNo
If hired, can you furnish proof you are eligible to work in the U.S.?*

YesNo
Were you ever employed here?*

YesNo
If yes, when?
Have you ever been convicted of a crime that was or is a felony or a misdemeanor?*

YesNo
If yes, give details. (A “Yes” answer does not automatically disqualify you from employment, since the nature of the offense, date of the offense, job for which you are applying and other factors are also considered.)
Do you have any relative(s) presently employed by the CEO?*

YesNo
Name

First NameLast Name
Relationship
Are you now or do you expect to be engaged in any other business or employment?*

YesNo
If yes, please explain.
EDUCATION
List Name and Address of Schools (any field that does not pertain to you, indicate "N/A")
High School or GED:*
Number of years completed*
Diploma/Degree/ Certificate*
College or University, Vocational or Technical :
Number of years completed
Diploma/Degree/ Certificate
Subjects Studied
SPECIAL SKILLS
What skills, additional training or special knowledge do you have that are related to the job for which you are applying? (Indicate "N/A" if you have no response)*
What machines or equipment can you operate that are related to the job for which you are applying? (Indicate "N/A" if you have no response)*
Answer the following questions only for jobs that require driving.
Do you have a car available for you to use?

YesNo
Do you have a valid driver’s license?

YesNo
Do you have automobile insurance coverage?

YesNo
Have you had your driver’s license suspended or revoked in the last 3 years?

YesNo
If yes, give details
List professional, trade, business or civic activities and explain your role in each. Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability or other protected status. (Indicate "N/A" if you have no response)*
Do you ever supervise groups?*

YesNo
If yes, identify what groups and your role in each:
WORK HISTORY
List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references. PLEASE GIVE MONTH AND YEAR.
Name of Employer
Supervisor
City, State, Zip Code
From (mo/yr)
To (mo/yr)
Start $
Final $
Reason for Leaving
Name of Employer
Supervisor
City, State, Zip Code
From (mo/yr)
To (mo/yr)
Start $
Final $
Reason for Leaving
Name of Employer
Supervisor
City, State, Zip Code
From (mo/yr)
To (mo/yr)
Start $
Final $
Reason for Leaving
Name of Employer
Supervisor
City, State, Zip Code
From (mo/yr)
To (mo/yr)
Start $
Final $
Reason for Leaving
REFERENCES
Have you worked or attended school under any other names?*

YesNo
If yes, give names
Are you presently employed?*

YesNo
If yes, whom do you suggest we contact?
Have you ever been fired from a job or asked to resign?*

YesNo
If yes, please explain.
Give three references, not relatives or former employers.
Name*

First NameLast Name
Email
example@example.com
Phone Number*
Please enter a valid phone number.
Name*

First NameLast Name
Email
example@example.com
Phone Number*
Please enter a valid phone number.
Name*

First NameLast Name
Email
example@example.com
Phone Number*
Please enter a valid phone number.
AFFIDAVIT and AUTHORIZATION
PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING
I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.

I understand that the Commission on Economic Opportunity (CEO) may request a consumer report from a consumer reporting agency. This report may include information as to my character, creditworthiness, general reputation, personal characteristics and mode of living. CEO may also request an investigative consumer report from a consumer reporting agency. This report may include information as to my character, general reputation, personal characteristics or mode of living obtained from interviews with neighbors, friends, former employers, schools and others. In the case of investigative consumer reports, I understand that I have a right to make a written request within a reasonable time for the disclosure of the name and address of the consumer reporting agency so that I may obtain a complete disclosure of the nature and scope of the investigation.

I authorize the investigation of any or all statements contained in this application. I understand that CEO conducts criminal background checks as part of the application process and I authorize CEO to request and obtain such information. I also authorize, whether listed or not, any person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.

I also authorize CEO to request and obtain consumer reports and investigative consumer reports at the time of my application for employment and while I am employed with CEO.

I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE.

I have read, understand and by my signature consent to these statements.
Signature*

Clear
Date*

MonthDayYear
Date
Applicant Email
example@example.com
Name*

First NameLast Name
Should be Empty:

COMMISSION ON ECONOMIC OPPORTUNITY

APPLICATION FOR EMPLOYMENT

An Equal Opportunity Employer

EDUCATION

List Name and Address of Schools (any field that does not pertain to you, indicate "N/A")

SPECIAL SKILLS

Answer the following questions only for jobs that require driving.

WORK HISTORY

REFERENCES

AFFIDAVIT and AUTHORIZATION

PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING