Application for Employment

Name *

First

Middle

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Required Information

Are you 18 years old or older? *

Yes
No

Are you legally eligible to work in the United States? *

Yes
No

Do you have a valid driver's license? *

Yes
No

Do you have access to a vehicle? *

Yes
No

Have you previously worked for the Council of Community Services? *

Yes
No

If you answered "YES" to the question above, please list your dates of employment, position title, department, and other names you may have been know as.

Do you have any family members currently working at the Council of Community Services? *

Yes
No

Employment Desired

Position you are applying for: *

Desired Salary Range

Date you can start *

Are you currently employed? *

Yes
No

If yes, may we contact your current employer?

Yes
No

General

Please indicate your United States military/veteran status:

Current or former member of the military
None

If you are fluent in a language/languages other than English, please list below.

Education and Employment Information

You may use the questions below to provide this information or you may upload a resume before submitting this form.

Education

Include name and location of school, number of years attended, degree/concentration received

High School

College/Trade School

Graduate/Continuing Education

Subjects of Special Study or Research Work

Any additional education/skill information you'd like to provide

Employment History

Employer #1 Name

Date Started

Date Ended (or today's date if currently employed)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Duties

Reason for Leaving

Employer #2 Name

Date Started

Date Ended

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Position

Duties

Reason for Leaving

Employer #3 Name

Date Started

Date Ended

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Position

Duties

Reason for Leaving

Employer #4 Name

Date Started

Date Ended

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Position

Duties

Reason for Leaving

References

List three professional/scholastic persons not related to you.

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email

Relationship and Years acquainted

Name

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email

Relationship and Years acquainted

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email

Relationship and Years acquainted

Additional Information

Please use the file uploads below to attach any relevant information (such as cover letter, resume, references, etc.)

File Upload

Click or drag a file to this area to upload.

File Upload

Click or drag a file to this area to upload.

File Upload

Click or drag a file to this area to upload.

Statement of Agreement

Please review the following statement and indicate your agreement: "I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice." *

Yes, I agree
No, I do not agree