P.O. BOX 1175 Hot Springs, AR 71902
PH: 501-624-5724/FAX: 501.624.1645
COMMUNITY SERVICES OFFICE
Employment Application
PLEASE READ CAREFULLY
Thank you for your interest in working for Community Services Office (CSO). Working at CSO is not just a job; it is a commitment to help our community. As reflected in our Mission, the Community Services Office, in partnership with the community, will focus on strengthening the educational, social, and economic well-being of individuals and families, as they move toward economic independence and self-sufficiency. All employees must meet certain requirements and obtain criminal, child, and adult maltreatment clearances. Employees must also have a valid driver's license and receive clearance through our automobile insurance provider, should the position require it. Failure to disclose criminal offenses, child or adult abuse, and major traffic violations on your application will result in the disqualification of your application. Any falsification of this information, discovered after employment, will result in disqualification/immediate termination.
If you are offered a position at CSO, you will report to the Human Resources Office to plan arrangements for a drug screen. Our intent to hire is contingent upon a negative drug screen result. Failure to pass the drug screen will disqualify your application. You must also submit the following documents to the Human Resources Office within the timeframes requested:
Copy of High School transcript/ GED Diploma
High School transcript / GED Diploma
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Copy of transcript from an accredited college or university (if applicable)
College / University Transcript
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Failure to meet any of the requirements set forth in this document will result disqualification of your application from the employment process. Falsification of any information on your application, discovered after employment, will result in disqualification/immediate termination.
Applicant's Signature
*
Date
*
-
Month
-
Day
Year
Date
CSO is an equal opportunity employer. We adhere to making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age and disability. We assure you that your opportunity for employment with OCC depends solely on your qualifications.
Revised 2/2021
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COMMUNITY SERVICES OFFICE
Employment Application
APPLICANT INFORMATION
Name
*
First Name
Middle Initial
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone
*
Format: (000) 000-0000.
E-mail Address
*
example@example.com
Date Available
*
-
Month
-
Day
Year
Date
Social Security No.
*
Position Applied for
Position applied for
*
Please Select
Early Head Start Teacher – Pine Bluff
Education Coach – Hot Springs
Head Start Teacher – Pine Bluff
Resume
*
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Cover Letter
*
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Days Available to Work
*
Any
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Hours Available to Work
7 a.m. - 3 p.m.
*
Yes
No
7:30 a.m. - 3:30 p.m.
*
Yes
No
7:30 a.m. - 4:00 p.m.
*
Yes
No
8 a.m. - 5 p.m.
*
Yes
No
8 a.m. - 5 p.m.
*
Yes
No
8 a.m. - 4:30 p.m.
*
Yes
No
9 a.m. - 5 p.m.
*
Yes
No
Are there other hours you're available to work?
Desired Salary (be specific)
*
Employment desired
*
Full-Time Only
Part-Time Only
Full or Part-Time
HAVE YOU EVER BEEN CONVICTED OF ACRIME?
*
YES
NO
If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.
What is your means of transportation to work?
*
Driver Type
Operator?
Commercial? (CDL)
Chauffeur?
EDUCATION
High School
*
Location
*
From
*
-
Month
-
Day
Year
Date
To
*
-
Month
-
Day
Year
Date
Did you graduate?
*
YES
NO
Degree
*
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College
Location
From
To
Did you graduate?
YES
NO
Degree
Other
Location
From
To
Did you graduate?
YES
NO
Degree
REFERENCES
Please list THREE references other than relatives or previous employers.
Reference 1 Full Name
*
First Name
Last Name
Relationship
*
Company
*
Phone:
*
Format: (000) 000-0000.
Address
*
Reference 2 Full Name
*
First Name
Last Name
Relationship
*
Company
*
Phone:
*
Format: (000) 000-0000.
Address
*
Reference 3 Full Name
*
First Name
Last Name
Relationship
*
Company
*
Phone:
*
Format: (000) 000-0000.
Address
*
Additional Information
An application form can sometimes make it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.
*
PREVIOUS EMPLOYMENT
Company 1
Phone
Format: (000) 000-0000.
Address
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilities
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Dates employed at Company 1
From
-
Month
-
Day
Year
Date
To
-
Month
-
Day
Year
Date
May we contact your previous supervisor for a reference?
YES
NO
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Company
Phone
Format: (000) 000-0000.
Address
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
Dates employed at Company 2
From
-
Month
-
Day
Year
Date
To
-
Month
-
Day
Year
Date
May we contact your previous supervisor for a reference?
YES
NO
List the jobs you held, duties performed, skills used or learned, advanc nents or promotion $ while you worked at this company.
Company 3
Phone
Format: (000) 000-0000.
Address
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
Dates employed at Company 2
From
-
Month
-
Day
Year
Date
To
-
Month
-
Day
Year
Date
May we contact your previous supervisor for a reference?
YES
NO
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked here.
May we contact your present employer?
YES
NO
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Did you complete this application?
*
YES
NO
If not, who did?
DISCLAIMER AND SIGNATURE: I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result In-termination.
Signature:
*
Date:
*
-
Month
-
Day
Year
Date
Revised 02/2021
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