Employment Application
We are an Equal Opportunity Employer
PRISM EDC provides reasonable accommodation to enable applicants with disabilities to participate in the job application and interview process. If you need assistance, please contact jonest@prismedc.org. PRISM EDC does not discriminate in hiring or employment on the basis of race, color, national origin, disability, sex, age, marital status or other legally protected status required by law.
Date
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Month
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Day
Year
Date
Name
*
Prefix
First Name
Middle Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
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Month
Please select a day
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Day
Please select a year
2026
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Year
What position are you applying for?
*
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How were you referred to us?
*
Walk-In
Referral
Newspaper Ad
Facebook
Twitter
LinkedIn
Other (please specify)
Embassy Center MKE
If under 18 are you able to provide a work permit?
*
Yes
No
Have you ever filed an application here before?
*
Yes
No
If yes, give a date when.
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Month
-
Day
Year
Date
Have you ever been employed here before?
*
Yes
No
If yes, give the dates when.
Are you currently employed?
*
Yes
No
If yes, may we contact your employer?
Are you a US citizen?
*
Are you a US Citizen? (Proof of citizenship or immigration status may be required upon employment.
*
Yes
No
If not a citizen, you have a valid permit=Yes
Employment Desired
*
Full Time
Part Time
Temporary
Internship
When are you available for work?
*
-
Month
-
Day
Year
Date
Are you on lay-off and subject to recall?
Yes
No
Can you travel if a job requires it?
Yes
No
What's your highest level of education?
*
Please Select
High School
College
Graduate School
Trade School
Name of the School?
Location (complete mailing address of the school)
Number of Years Completed
Major/ Degree
Driver's License
only for positions that require driving
Do you have a valid drivers license?
Driver's License Number
Expiration Date of License
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Month
-
Day
Year
Date
Have you had any accidents during the past 3 years? (If yes, how many?)
Have you had any moving violations during the last 3 years? (If yes, how many?)
Military
Are you a veteran of the United States Military Service? (If yes, what branch?)
*
If yes, date of entry to service and date of discharge?
If yes, please describe any special skills or training acquired while in service?
Other Special Skills: Please list other special skills you may have, e.g., fluency in other languages, licenses, special training required for the position for which you are applying, etc. Skills in fund development, non-profit management, public speaking, cross-cultural competency training and video production.
Work Experience
Please list you work experience beginning with your most recent job. If you were self-employed, give firm name. Attach additional sheets if necessary. Exclude organization names which indicate race, color, creed, national origin, age, religion, sexual orientation, gender identity, gender expression, veteran status, or disability.
Please list your work experience
*
Rows
Most Recent Employer
Address
Supervisor and Phone #
Reason for Leaving?
Job Title
Date Employed (From-To) * include mo/year
Starting Salary
Ending Salary
Job
Job
Job
Resume and Files
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
References
Please list two (2) references other than relatives or previous employers
Reference
*
Reference
*
WAIVERS AND DISCLOSURES
Please read each section carefully and sign where indicated
AT-WILL EMPLOYMENT
It is my understanding that this employment application, or the granting of an oral interview, does not represent a contract of employment or a promise of future benefits by this organization. I understand and agree that if hired, my employment will be at-will employment in nature and may be terminated, with or without cause, at any time, by either myself or my employer. I also understand that this written statement supersedes any and all oral representations made by agents or representatives of this organization.
CERTIFICATION OF TRUTH AND ACCURACY
I certify that the information in this application is true, complete, and correct. I understand that false statements, or significant omissions made by me on this form shall be sufficient cause for denial of employment or discharge.
NOTICE AND AUTHORIZATION TO REQUIRE A MEDICAL EXAMINATION
I hereby certify that, if hired, I will disclose any limitations I have that may impact my ability to perform the job. I understand that I may also be required to undergo a pre-employment or post-employment medical exam by Prism EDC’s designated health provider if needed.
I certify that information contained in this application is true and complete. I understand that false information may be grounds for termination or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.
Signature
*
If under 18, can you provide a work permit?
Yes
Submit Application
Submit Application
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