Application for Employment

Application for Employment
Personal Information:
Name*

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a US Citizen or do you hold an authorization to work in the US (you will be requested to provide a copy of your work permit at the time of employment)?*

YesNo
What languages do you speak?
Please list all
Do you have a driver's license?*

YesNo
Do you have consistent access to a reliable vehicle?*

YesNo
Have you ever been convicted of a felony?*

YesNo
If yes, please explain:

Education & Employment:
Highest level of education:*

I do not have a GED or High School DiplomaGEDHigh School DiplomaSome collegeDegree/Graduate Degree
Certificates or licenses held:
List any relevant certificates or qualifications
Additional training:
Current employer:*
Current job title:*
Duties performed:*
Reason for leaving:*
Start date:*

MonthDayYear
Date
May we contact your employer?*

YesNo
If yes, please provided the name and phone number of a supervisor who we can contact.
Supervisor's name:

First NameLast Name
Supervisor's phone number:
Please enter a valid phone number.

References:

Please provide the contact information for two references who have known you for more than three years. References should not be related to you.
Reference Name:*

First NameLast Name
Relationship:*
Years acquainted:*
Should be no less than three
Reference phone number:*
Please enter a valid phone number.
Reference Name:*

First NameLast Name
Relationship:*
Years acquainted:*
Should be no less than three
Reference phone number:*
Please enter a valid phone number.

Upload Resume (Optional)

Cancelof
By clicking the submit button below, I certify that all of the information provided by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed by one of our affiliates, my employment may be terminated at any time. In consideration of my employment, I agree to conform to Easterseals Alaska's rules and regulations. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.
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