Step 1 of 5 : Personal Information

    Full Name*

    Address Line 1*

    Address Line 2

    City*

    State*

    Zip*

    Home Phone*

    Work Phone/Cell*

    Message Phone*

    Are you under age 18?*

    YesNo

    If "YES", can you provide proof of your eligibility to work?

    YesNo

    Have you ever worked or volunteered at a non-profit agency?

    YesNo ( If Yes, please explain )

    Have you ever been convicted of a felony?

    YesNo ( If Yes, please explain )


    Step 2 of 5 : Work Preferences

    Are you currently authorized to work in the United States?

    YesNo

    ( Proof of eligibility will be required if hired. )

    Position applied for

    Days / hours available to work

    No Pref

    Mon

    Tue

    Wed

    Thur

    Fri

    Sat

    Sun

    How many hours can you work weekly?

    How did you learn of this opening?

    NewspaperTemporary ServicesVocational RehabilitationEmployment DepartmentWebsiteNewsletterFriend/co-workerOther

    Employment desired

    Full-Time OnlyPart-Time OnlyTemporary / Contract

    When are you available to start work?


    Step 3 of 5 : Education

    High School

    Location

    Number of Years completed

    Major & Degree


    College

    Location

    Number of Years completed

    Major & Degree


    Professional School

    Location

    Number of Years completed

    Major & Degree


    Certifications

    Certification

    Where Certified

    Proof of Certification

    Certification

    Where Certified

    Proof of Certification

    Certification

    Where Certified

    Proof of Certification


    Step 4 of 5 : Work Experience

    Military

    Have you ever been in the Armed Forces?

    YesNo

    Are you now a member of the Armed Forces?

    YesNo

    Basic Active Service Date

    Discharge Date

    Please list your work experience with your most recently held job. If you were self-employed, give firm name.

    Employer

    Address

    Your Title

    Supervisor’s Name / Phone Number

    May we contact?
    YesNo

    From (Month & Year)

    To (Month & Year)

    Gross Monthly Salary $

    Average hours worked per week

    Major Duties (be specific)

    Reason for leaving (be specific)


    Employer

    Address

    Your Title

    Supervisor’s Name / Phone Number

    May we contact?
    YesNo

    From (Month & Year)

    To (Month & Year)

    Gross Monthly Salay $

    Average hours worked per week

    Major Duties (be specific)

    Reason for leaving (be specific)


    Employer

    Address

    Your Title

    Supervisor’s Name / Phone Number

    May we contact?
    YesNo

    From (Month & Year)

    To (Month & Year)

    Gross Monthly Salay $

    Average hours worked per week

    Major Duties (be specific)

    Reason for leaving (be specific)

    List Three Professional References

    Name

    Phone

    Email


    Name

    Phone

    Email


    Name

    Phone

    Email

    Clerical Skills

    This section is to be completed if you are applying for any clerical/office positions. Check all skills in which you are fully proficient.

    General Office Skills
    Typing Speed WPMSupervisory experienceTen-key adding machineFile maintenanceCash RegisterAmerican Sign LanguageMulti-line TelephonePreparing Purchase OrdersBookkeepingPreparing Journal VouchersProofreading documents for grammer, spelling and sentence StructureEditing documents for form, content and consistencyPublic contact answering routine questionsPublic contact dealing with angry, confused or hostile persons

    Computer Skills
    WordExcelMS Office 2010Quickbooks ProWindows 7Other

    Special Skills


    Step 5 of 5 : Cover Letter and Resume

    Cover Letter

    Resume


    Field marked with an * are required

    This information is only used for the purposes of filling out and submitting this application form.