Employment Application (CSFS) (All Office)

Employment Application

Client Services Field Supervisor
Bridges offers equal employment opportunities to all persons without regard to race, religion, age, sex, color, national origin, ancestry, disability, uniformed service, union affiliation or other legally protected status. No question on this application is intended to secure information to be used to discriminate on these bases.

Please carefully read all the questions. If you do not understand a question, please ask for an explanation. Answer all questions fully, honestly and completely. Do not leave any questions blank. If the question does not apply to you, enter "n/a" to indicate that the question is "not applicable." Failure to follow these instructions will be considered by Bridges in making employment decisions. Any false, misleading or incomplete answers may result in immediate disqualification of consideration for employment or termination of subsequent employment.

The use of this form does not mean there are positions open and does not obligate Bridges in any way. Your employment application will be considered active for 60 days. You must reapply if you wish to be considered for employment beyond this period of time.
Bridges Office Location Applying to: *
Personal Information:
Full Name *

First Name Middle Name Last Name

Address *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Phone Number *
Email
Birth Date *

Month Day Year
Social Security Number *
Are You a U.S. Citizen? *

Yes No
Do you have a driver's license? *

Yes No
Have you Previously Worked for Bridges? *

Yes No
Employment Desired:
Date You Can Start

Month Day Year
Status Desired

Click in cells that you are available to work. Please check all days/shifts available. Leave days / shifts blank that you are not available

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

Day Shift

Evening Shift

Overnight Shift

NOTE: Answering “Yes” to the following two questions does not constitute an automatic bar to employment. However, failure to fully disclose requested information may result in denial of application or termination of employment. (Do not include matters which have been sealed or expunged in answering the following two questions.)
Have you been convicted of a crime not expunged by the court? *

Yes No
If Yes, Please explain:
Do you have any charges currently pending against you? *

Yes No
If yes, give date and details:
Are you excluded from participation in Federal or State healthcare programs?

Yes No
Education:
High School
Name of High School Attended
Number of Years Attended
Graduated?

Yes No
College
Name of College/University Attended
Area of Study/Degree
Number of Years Attended
Graduated?

Yes No
Graduate School
Name of Graduate School Attended
Area of Study/Degree
Number of Years Attended
Graduated?

Yes No
Trade School/Other
Name of Trade/Technical/Other School Attended
Area of Study/Degree
Number of Years Attended
Graduated?

Yes No
Skills/Qualifications:
Skills
List any relevant skills
Qualifications
List any relevant certifications or qualifications
Current Employment:
Current Employer
Name of Current Employer or NONE if not Employed
Position
Salary
Reason for Leaving?
Start Date

Month Day Year
Phone Number
May We Contact?

Yes No
Previous Employment:
Previous Employer
Name of Previous Employer
Position
Salary
Reason for Leaving?
Start Date

Month Day Year
End Date

Month Day Year
Phone Number
May We Contact?

Yes No
Previous Employer
Name of Previous Employer
Position
Salary
Reason for Leaving?
Start Date

Month Day Year
End Date

Month Day Year
Phone Number
May We Contact?

Yes No
References:
Personal Reference *
Name of Reference
Relationship *
Phone Number *
Years Acquainted *
Professional Reference *
Name of Reference
Relationship *
Phone Number *
Years Acquainted *
APPLICANT CERTIFICATION AUTHORIZATION AND RELEASE

By signing below and clicking the submit button below, I certify that the information contained in this application is true and complete to the best of my knowledge. I understand that any falsification, misrepresentation or omission on this application or during a subsequent interview is grounds for refusal to hire, or if hired, dismissal.

I voluntarily authorize Bridges to request, receive and use information concerning me from any present or former employer, educational institution, law enforcement or other government agency, judicial system, financial institution, or other person or entity having knowledge about me. I further voluntarily authorize any and all of the above persons or entities to release information they may have about me to Bridges or its agents, and I release all parties from any and all liability for disclosing and/or reviewing such information.

I understand that nothing contained in this application or in the granting of an interview creates a contract between Bridges and me either for employment or for the providing of any benefit. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon Bridges unless made in writing by an authorized representative.

I understand that, if I am hired, I will be an at-will employee, which means that either I or Bridges may terminate the employment relationship at any time, with or without cause or notice.

I understand that in addition to the initial pre-employment drug screen, I may be requested to submit to another drug screen for the following reasons while on the job:
- Immediately after reporting an injury to you related to worker’s compensation.
- Immediately after being involved in a moving vehicle accident
- Immediately after a consumer injury occurring under my supervision
- Or at random times throughout employment, once the 180-day evaluation period is completed.
I HAVE CAREFULLY READ THIS ENTIRE EMPLOYEMENT APPLICATION AND FULLY UNDERSTAND ALL OF ITS CONTENTS AND INSTRUCTIONS.
Date *

Month Day Year
Date
Signature (Use your mouse or finger to sign below)
Send Application:
Should be Empty:

Employment Application

Personal Information:

Employment Desired:

Education:

Skills/Qualifications:

Current Employment:

Previous Employment:

References:

Send Application: