Easterseals AK Personnel Application

Address *

Phone Number *

Area Code Phone Number
E-mail *
Are You a U.S. Citizen? *

Yes No
*If not a U.S. Citizen, a copy of work permit will need to be provided at time of employment.
Do You Own A Car? *

Yes No
Do You Have A Drivers License? *

Yes No
Distance Willing To Travel? *
What Languages Do You Speak?
In Case of Emergency, Notify:
Name & Relationship
Emergency Contact Phone Number

Area Code Phone Number
Activities / Interests
List some activities and interests that you have.

Skills/Qualifications:
Additional Training *
List further training which you have received in business, technical, nursing, service schools, colleges or by correspondence.
Certificates or Licenses Held:
List any relevant certifications or qualifications

References:

We require three references from persons who have known you for three years or more. *References may not be family members.
Reference 1 *
Name of Reference
Relationship *
Relationship to applicant
Years Acquainted *
Phone Number *

Area Code Phone Number
Email *
For reference letter purposes
Reference 2 *
Name of Reference
Relationship *
Relationship to applicant
Years Acquainted *
Phone Number *

Area Code Phone Number
Email *
For reference letter purposes
Reference 3 *
Name of Reference
Relationship *
Relationship to applicant
Years Acquainted *
Phone Number *

Area Code Phone Number
Email *
For reference letter purposes

Cover Letter & Resume:
Cover Letter
Resume
Send Application:
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, ommissions, 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.
Signature

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