Employment Application

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Application for Employment

(Pre-Employment Questionnaire - An Equal Opportunity Employer)

FILL OUT ALL INFORMATION

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.

[{"type":"textarea","required":true,"label":"Position(s) applied for ","name":"Positions-applied-for","subtype":"textarea","className":"d-block"},{"type":"text","required":true,"label":"First Name","name":"first-name","maxlength":24,"className":"col-lg-4","subtype":"text"},{"type":"text","label":"Middle Name","name":"middle-name","maxlength":24,"className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"Last Name","name":"last-name","maxlength":24,"className":"col-lg-4","subtype":"text"},{"type":"date","label":"Date of application ","name":"Date-of-application","className":"d-block"},{"type":"text","required":true,"label":"Telephone #","name":"Telephone-","className":"d-block","subtype":"text"},{"type":"text","required":true,"label":"Address","name":"Address","className":"d-block","subtype":"text"},{"type":"text","subtype":"email","required":true,"label":"Email","name":"email","className":"col-md-6"},{"type":"text","subtype":"email","required":true,"label":"Email Confirmation","name":"email-confirmed","className":"col-md-6"},{"type":"text","label":"Referral Source (How did you hear about us?)","name":"Referral-Source","className":"d-block","subtype":"text"},{"type":"text","required":true,"label":"Have you ever been employed here before? If yes, give dates and positions:","name":"Have-you-ever-been-employed-here-before","className":"d-block","subtype":"text"},{"type":"select","required":true,"label":"Are you legally eligible for employment in this country?","name":"Are-you-legally-eligible-for-employment-in-this-country","className":"d-block","values":[{"label":"Yes","value":"Yes","selected":true},{"label":"No","value":"No"}]},{"type":"date","required":true,"label":"Date available for work","name":"Date-available-for-work","className":"d-block"},{"type":"text","label":"What is your desired salary range?","name":"What-is-your-desired-salary-range","className":"d-block","subtype":"text"},{"type":"select","label":"Are you able to perform the essential functions of the job for which you are applying (with or without reasonable accommodations(s)?","name":"Are-you-able-to-perform-the-essential-functions-of-the-job-for-which-you-are-applying-with-or-without-reasonable-accommodationss","className":"d-block","values":[{"label":"Yes","value":"Yes"},{"label":"No","value":"No"},{"label":"Need more information about the job's \"essential\" functions\" to respond","value":"Need more information about the job's 'essential'"}]},{"type":"text","label":"License # and State","name":"License--and-State","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<div><br></div><div><br></div><div><br></div>Answering \"yes\" to either of the following questions does not constitute an automatic bar to employment. Factors such as date of the offence, seriousness, and nature of the violation, rehabilitation and position applied for will be taken into account. ","className":"d-block"},{"type":"text","required":true,"label":"Have you ever pleaded \"guilty\" or \"no contest\" to, or been convicted of a crime? If yes, please provide date(s) and details:","name":"Have-you-ever-pleaded-guilty-or-no-contest-to-or-been-convicted-of-a-crime","className":"d-block","subtype":"text"},{"type":"header","subtype":"h4","label":"EMPLOYMENT HISTORY","className":"col-md-6"},{"type":"paragraph","subtype":"p","label":"Starting with your most recent employer, provide the following information of past three places of employment:<div><span style=\"font-family: var(--bs-body-font-family); text-align: var(--bs-body-text-align);\">    Employer      </span></div><div><span style=\"font-family: var(--bs-body-font-family); text-align: var(--bs-body-text-align);\">    </span><span style=\"font-family: var(--bs-body-font-family); text-align: var(--bs-body-text-align);\">Summarize the type of work performed and job responsibilities.</span><span style=\"font-family: var(--bs-body-font-family); text-align: var(--bs-body-text-align);\">                                                                                          </span></div><div>    Job title (include dates)<span style=\"font-family: var(--bs-body-font-family); text-align: var(--bs-body-text-align);\">                              </span><span style=\"font-family: var(--bs-body-font-family); text-align: var(--bs-body-text-align);\">                                                  </span><span style=\"font-family: var(--bs-body-font-family); text-align: var(--bs-body-text-align);\">           </span></div><div>    Why did you leave?</div><div> </div><div><br><div><br></div></div>","className":"d-block"},{"type":"text","required":true,"label":"EMPLOYER","name":"Employer","className":"d-block","subtype":"text"},{"type":"text","required":true,"label":"Summarize work performed and responsibilities","name":"Job-description","className":"d-block","subtype":"text"},{"type":"date","required":true,"label":"Start date","name":"start","className":"d-block"},{"type":"date","required":true,"label":"End date","name":"end","className":"d-block"},{"type":"text","required":true,"label":"Why did you leave","name":"Why-did-you-leave","className":"d-block","subtype":"text"},{"type":"text","required":true,"label":"EMPLOYER ","name":"Employer","className":"d-block","subtype":"text"},{"type":"text","required":true,"label":"Summarize work performed and responsibilities","name":"Job-description","className":"d-block","subtype":"text"},{"type":"date","required":true,"label":"Start date","name":"start","className":"d-block"},{"type":"date","required":true,"label":"End date","name":"end","className":"d-block"},{"type":"text","label":"Why did you leave?","name":"Why-did-you-leave","className":"d-block","subtype":"text"},{"type":"text","label":"EMPLOYER","name":"Employer","className":"d-block","subtype":"text"},{"type":"text","label":"Summarize work performed and responsibilities","name":"Job-description","className":"d-block","subtype":"text"},{"type":"date","label":"Start date","name":"start","className":"d-block"},{"type":"date","label":"End date","name":"end","className":"d-block"},{"type":"text","label":"Why did you leave?","name":"Why-did-you-leave","className":"d-block","subtype":"text"},{"type":"file","label":"<div>RESUME UPLOAD</div>Please select one or more files for upload. You may upload up to 20 files (35 Mb max). Files can be PDF, JPG, JPEG format. To upload multiple files, please hold control while clicking on multiple files before clicking \"Open\".","name":"Resume","subtype":"file","multiple":true,"className":"d-block"},{"type":"header","subtype":"h4","label":"SKILLS AND QUALIFICATIONS","className":"col-md-6"},{"type":"text","required":true,"label":"Summarize any special training, skills, licenses and/or certifications that may assist you in performing the position for which you are applying:","name":"Summarize-any-special-training-skills-licenses-andor-certifications-that-may-assist-you-in-performing-the-position-for-which-you-are-applying","className":"d-block","subtype":"text"},{"type":"header","subtype":"h4","label":"EDUCATION","className":"col-md-6"},{"type":"textarea","required":true,"label":"Starting with your most recent school attended, provide the following information:<div>      School (include City and State)                                                   Completion date</div>","name":"Completed-Education","subtype":"textarea","className":"d-block"},{"type":"header","subtype":"h4","label":"REFERENCES","className":"col-md-6"},{"type":"paragraph","subtype":"p","label":"List name and telephone number of two business/work references who are NOT related to you and are NOT previous supervisors. If not applicable, list three school or personal references who are NOT related to you. <div class=\"clear\"></div>","className":"d-block"},{"type":"text","required":true,"label":"Reference","name":"Reference","className":"d-block","subtype":"text"},{"type":"text","required":true,"label":"Telephone #","name":"Telephone","className":"d-block","subtype":"text"},{"type":"text","label":"Reference","name":"Reference","className":"d-block","subtype":"text"},{"type":"text","label":"Telephone #","name":"Telephone","className":"d-block","subtype":"text"},{"type":"header","subtype":"h4","label":"APPLICANT STATEMENT","className":"col-md-6"},{"type":"paragraph","subtype":"p","label":"  I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.<div>  I expressly authorize without reservations, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations, or organizations for furnishings such information about me.</div><div>  I understand that this employer does not unlawfully discriminate in employment and on question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. </div><div>  I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application. </div><div>  If I am hired, I understand that I am free to resign at any time, with or without case and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurance to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.</div><div>  I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.</div><div>  This Company does not tolerate unlawful discrimination in its employment practices. No questions on this application are used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status applicable federal, state or local law. This company likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, age, disability or any other protected status. <span style=\"font-family: var(--bs-body-font-family); text-align: var(--bs-body-text-align);\">The company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly. </span></div><div>  I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.</div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.<div>I certify that I have read, fully understand and accept all terms of the forgoing Applicant Statement.</div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"text","required":true,"label":"Applicant Signature","placeholder":"By typing your name you are signing this form","name":"applicant-signature","className":"col-md-6","subtype":"text"},{"type":"date","required":true,"label":"Signature Date","name":"signature-date","className":"col-md-6"}]

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Employment Application