Community Justice Worker Application

Community Justice Worker Application
Applicant Information
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Volunteer Position Applying For (please choose one)
Name

First NameMiddle NameLast Name
Present Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number(s)
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Are you able to complete training programs? (approximately 4 hrs. a week for 9 weeks)
Will you be able to take one case per month?
If you are bi-lingual, what languages do you speak, read, or write?
Work Experience
List your most recent employers. Use the notes field if you need to add more than three.
Employer 1 – Dates of Employment From

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer 1 – Dates of Employment To

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer 1 – Employer Name, Address & Phone
Employer 1 – Salary
Employer 1 – Position Title
Employer 1 – Supervisor Name

First NameMiddle NameLast Name
Employer 1 – Reason for Leaving
Employer 2 – Dates of Employment From

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer 2 – Dates of Employment To

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer 2 – Employer Name, Address & Phone
Employer 2 – Salary
Employer 2 – Position Title
Employer 2 – Supervisor Name

First NameMiddle NameLast Name
Employer 2 – Reason for Leaving
Employer 3 – Dates of Employment From

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer 3 – Dates of Employment To

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer 3 – Employer Name, Address & Phone
Employer 3 – Salary
Employer 3 – Position Title
Employer 3 – Supervisor Name

First NameMiddle NameLast Name
Employer 3 – Reason for Leaving
Education
Name & Location of School (High School)
Course of Study (High School)
Did You Graduate? (High School)
Name & Location of School (College)
Course of Study (College)
Did You Graduate? (College)
Name & Location of School (Other Training)
Course of Study (Other Training)
Did You Graduate? (Other Training)
Professional / Employment References
List up to three references.
Reference 1 Name

First NameMiddle NameLast Name
Reference 1 Email Address
example@example.com
Reference 1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 1 Company Name
Reference 2 Name

First NameMiddle NameLast Name
Reference 2 Email Address
example@example.com
Reference 2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 2 Company Name
Reference 3 Name

First NameMiddle NameLast Name
Reference 3 Email Address
example@example.com
Reference 3 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 3 Company Name
Personal References
List up to two references.
Personal Reference 1 - Name

First NameMiddle NameLast Name
Personal Reference 1 - Email Address
example@example.com
Personal Reference 1 - Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Personal Reference 1 - Company Name
Personal Reference 2 - Name

First NameMiddle NameLast Name
Personal Reference 2 - Email Address
example@example.com
Personal Reference 2 - Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Personal Reference 2 - Company Name
Legal/Background Questions
Do you have the legal right to work in the United States?
Have you ever been convicted of a felony?
Have you ever been convicted of a misdemeanor?
If you answered yes to either conviction question, please provide the date(s) of conviction and details of each.
Please note a conviction will not necessarily disqualify you from volunteering. The job-related nature of the violation will be considered.
Acknowledgments & Signature
Realizing that this organization has the right to employ persons who will provide high standards of service, I understand and agree that this application will be given consideration, but is not a promise of acceptance.

I also agree and understand the following conditions of employment:

That any falsification, misrepresentation or omission, either in this application, during interviews or in connection with any background investigation, may be grounds for invalidation of this application.

As part of the normal employment application process, a representative of Community Legal Services may verify information on this application including inquiries about my current and former employment, character, general reputation, and personal characteristics through interviews with current and former employers or other individuals or agencies.

Submitting this application in no way assures me a position with Community Legal Services and this application is not a contract of employment.
15) I have read, understand, agree and accept the above statements.
Signature of Applicant
Date of Signature

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Community Justice Worker Application

Applicant Information

Work Experience

Education

Professional / Employment References

Personal References

Legal/Background Questions

Acknowledgments & Signature