Employment Application Personal InformationWhat is the position you are applying for?*Resume UploadAccepted file types: pdf, doc, docx, txt, rtf, odt, pages, wpd, png, jpg, jpeg.Cover Letter UploadAccepted file types: pdf, doc, docx, txt, rtf, odt, pages, wpd, png, jpg, jpeg.How Did you Learn About Us- Select One -AdvertisementWord of MouthOur WebsiteEmployment AgencyWalk InOtherName* First Middle Last Address* Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Email If you are under 18 years of age, can you provide required proof of your eligibility to work?*- Select One -YesNoHave you ever filed an application with us before?*- Select One -NoYesPlease indicate date: Have you ever been employed with us before?*- Select One -NoYesPlease indicate date: Are you currently employed?*- Select One -YesNoMay we contact your present employer?*- Select One -YesNoAre you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?*Proof of citizenship or immigration status will be required upon employment.- Select One -NoYesOn what date would you be available for work?* Are you available to work:* Full Time Part Time Shift Work Temporary Do you have a valid driver’s license if required?*- Select One -YesNoCan you travel if a job required it?*- Select One -YesNoEducationSchool NameCity, StateDegree or Diploma Received or Level CompletedMajor/Course of StudyDescribe any specialized training, apprenticeship, skills and extra-curricula activities.Describe any honors you have received.State any additional information you feel may be helpful to us in considering your application.List professional, trade, business or civic activities and offices held. You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, handicap or other protected status. Add Additional Education/SchoolingRemove Education/SchoolReferencesPlease provide the name, email address, and telephone number of three references we may contact.Name*Phone*Email Name*Phone*Email Name*Phone*Email Employment ExperienceEmployerAddress City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code PhoneYour Job TitleName of SupervisorDate Started Date Ended Do you currently work here? Yes, I do Reason for LeavingStarting Hourly Rate/SalaryEnding Hourly Rate/SalaryJob Description/Work Performed Add Additional Work ExperienceRemove Work ExperienceApplicant's Statement This Employment Application is used to notify me that the nature and scope of an investigation, if one is conducted, could include such general identification information as residence verification, and as applicable, information concerning my employment, education, general reputation, character, personal characteristics and habits, and that such information may be developed through personal interviews with third parties such as family members, neighbors, friends, associates, former employers, and custodians of official records. Only job-related information developed from such a report will be considered in evaluating my employment application or continued employment. I hereby authorize these persons, companies, organizations or corporations to answer all questions or release any information regarding the items listed in this paragraph. I hereby release them from any liability and hold them harmless from any claim for releasing any truthful information within their knowledge and/or records. I authorize the Agency to release to any person, firm, entity or organization with which I may seek employment in the future, any truthful information concerning my work experience with the Agency and I hereby release and hold the Agency harmless from any claim for releasing any truthful information within its knowledge and/or records. I understand that neither this application nor any written personnel procedure manual or employee handbook is an express or implied contract of permanent employment. I further understand that my relationship with the Agency is "at-will" and for an unspecified term and that the Agency and I each have the right to terminate the employment relationship at any time, with or without cause or advance notice. I certify that the answers given by me to the foregoing questions and during any interviews are true and correct without consequential omissions, and understand that, if employed, omissions and/or false statements on this application or during any interviews may result in dismissal. I have had an opportunity to have my questions about this statement's contents and intent answered and understand its terms.* Yes I agree to all of the above statements* Yes Affirmative Action SurveyDear Applicant: Thank you for your interest in Community Action Partnership. Our agency is interested in reaching the broadest possible group of qualified applicants. This survey has been devised to assist us in monitoring the effectiveness of our recruitment efforts and to assist in collecting data which is required for compliance with State and Federal reporting requirements. Your cooperation in the timely completion and return of this form is most appreciated. While your reply will be most helpful to us in carrying out our administrative responsibilities, return of this form is entirely voluntary. This form will be kept in the Human Resources Department Office and will not be made available to the department. Thank you for your cooperation.SexMaleFemaleDo not discloseEthnic Background Hispanic or Latino White(not Hispanic or Latino) Black or African American (Not Hispanic or Latino) Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) Asian (Not Hispanic or Latino) American Indian or Alaska Native (Not Hispanic or Latino) Two or More Races (Not Hispanic or Latino) Sign and Submit Please read, initial, and sign/date. Please initial and date for your electronic signature. If you are interviewed, we will require your signature at the time of the interview. This application is current only for thirty (30) days, at the conclusion of which time, if you have not heard from us and still wish to be considered for employment, it will be necessary for you to fill out a new application.Intial*Date*PhoneThis field is for validation purposes and should be left unchanged.