EMPLOYMENT & INTERN APPLICATION
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GENERAL INFORMATION
Full Name
*
Prefix
First Name
Middle Name
Last Name
Suffix
List other names you have been known
Are you 18 Years or Older?
*
Yes
No
Are you authorize to work lawfully in the United States?
*
Yes
No
Have you ever been convicted of a felony or misdemeanour?
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Yes
No
CONTACT INFORMATION
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number
*
Mobile Phone Number
*
E-mail
*
example@example.com
TRANSPORTATION
Do you have a Driver's License?
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Yes
No
AVAILABILITY
Some weekends may be required for events and etc.
For which location are you applying for?
*
Your Business CCC LLC
Release it Counseling
Daughters of Zion Restoration Inc
Date Available
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-
Month
-
Day
Year
Date
Employment Type Desired
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Full Time
Part Time
Intern- Release it Counseling
Please select the position you are applying for
*
Executive Assistant
Therapist
Clinical Intern
Homeless Shelter Case manager
Expected Hourly Rate
Amount in $
Please state how many hours you can work?
Monday
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Tuesday
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Wednesday
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Thursday
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Friday
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
EDUCATION
*
SCHOOL (Name & Address)
COURSE
DEGREE TYPE
YEAR GRADUATED
HIGHSCHOOL
COLLEGE / UNDERGRADUATE
GRADUATE / PROFESSIONAL
CERTIFICATE & LICENSES
SPECIALIZED EXPERIENCE, VOLUNTEER WORK, TRAINING, SKILLS
Tell us About Yourself
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WORK HISTORY
EMPLOYER I
*
Position
*
Job Description
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Month & Year
*
Salary
Phone Number
*
Are you still employed here?
Please Select
Yes
No
Reason for Leaving
_______________________________________________________________________________________
EMPLOYER II
Position
Job Description
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Month & Year
Salary
Phone Number
Reason for Leaving
_______________________________________________________________________________________
EMPLOYER III
Position
Job Description
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Month & Year
Salary
Phone Number
Reason for Leaving
PERSONAL REFERENCES
Name
*
Relationship
*
Contact Number
*
Reference Email
*
example@example.com
Name
*
Relationship
Contact Number
*
Reference Email
*
example@example.com
Name
*
Relationship
Contact Number
*
Email
*
example@example.com
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Have you ever been convicted of a felony?
*
Please Select
Yes
No
If you answered yes, to the above question, please describe here.
Have you ever been convicted of any Consumer Fraud? (Consumer Fraud is described as; Identity Theft, Mortgage Fraud, Credit and Debit Card Fraud, Deceptive Interest Rate Reduction Robocalls, Fake Charities Prize and Lottery Fraud, Debt Collection Fraud, COVID-19 Scams)
*
Please Select
Yes
No
If you answered yes, please explain here.
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