Application for Employment
Family Service Agency considers applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.
Position(s) applied for
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How did you learn about Family Service Agency?
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Employment Agency
Friend
Relative
Walk-In
Other
Are you available to work:
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Full Time
Part Time
Shift Work
Temporary
On what date would you be available for work?
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Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
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example@example.com
Social Security Number
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If you are under 18 years of age, can you provide required proof of eligibility to work?
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Yes
No
N/A
Have you ever been employed with us before?
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Yes
No
If yes, give date
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Have you ever filled out an application with us before?
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Yes
No
If yes, give date
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Are you currently employed?
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Yes
No
May we contact your current employer?
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Yes
No
N/A
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
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Yes
No
Are you currently on lay-off status and subject to recall?
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Yes
No
Can you travel if a job requires it?
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Yes
No
Do you have a vehicle, current license, and insurance?
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Yes
No
Other
Education, Training, and Skills
Please provide the name and address of each school you have attended (including high school, college, or university). For each, list your course of study, years completed, and any diploma or degree earned.
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Please describe any specialized training, apprenticeship, skills, or United States Military training, clinical certifications, special job-related skills, experience, or foreign language proficiencies:
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Please check the space for each software program which you are PROFICIENT:
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Word
Publisher
Excel
Outlook
Canva
Other
References (Professional References ONLY)
Reference 1: Please provide the individual’s name, your relationship to them, and their phone number or email address.
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Reference 2: Please provide the individual’s name, your relationship to them, and their phone number or email address.
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Reference 3: Please provide the individual’s name, your relationship to them, and their phone number or email address.
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Employment Experience (Begin with your present or most recent job)
Employer 1: Please provide the employer’s name, telephone number, your job title, reason for leaving, dates of employment, supervisor’s name, and a general description of the work you performed.
Employer 2: Please provide the employer’s name, telephone number, your job title, reason for leaving, dates of employment, supervisor’s name, and a general description of the work you performed.
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Employer 3: Please provide the employer’s name, telephone number, your job title, reason for leaving, dates of employment, supervisor’s name, and a general description of the work you performed.
Employer 4: Please provide the employer’s name, telephone number, your job title, reason for leaving, dates of employment, supervisor’s name, and a general description of the work you performed.
Family Service Agency of DeKalb County, Inc. is an equal opportunity employer.
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