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.