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.