Application for Employment

We consider all applicants for all positions without regard to race, color, religion, creed, gender, national origin, disability or age.

Position Applied for *

Date Of Application *

Name *

First

Middle

Last

social security # *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Telephone Number (s) (house phone, cell phone) *

Email *

How did you learn about the position? *

Are you bilingual? *

Yes
No

If Yes, What languages do you speak? Please list:

If you are under 18 years of age, can you provide proof of your eligibility to work? *

Yes
No

Have you ever been employed here before? *

Yes
No

If yes, give dates and position

Do you possess a valid driver’s license? *

Yes
No

Do you possess a valid commercial driver’s license?

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Is this application a request for reemployment following an extended military leave of absence from this company. *

Yes
No

Are you legally eligible for employment in this country? *

Yes
No

Date available for work *

What is you desired salary range? *

Type of employment desired *

Full-Time
Part-Time
Substitute

Are you able to perform the “essential functions” of the job for which you are applying (with or without reasonable accommodations)? This question is not designed to elicit information about an applicant’s disability. Please do not provide information about the existence of a disability, particular accomodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law. *

Yes
No
Need more information about the job’s “essential functions” to respond

Driver’s license number required if driving may be required in the job for which you are applying

Drivers License State

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Employment History

Starting with your most recent employer, provide the following information.

Most Recent Employer

Company Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Starting Job Title *

Final Job Title *

Immediate Supervisor and Title (for most recent position held) *

Why did you leave? *

Dates employed: *

Month Year to Month Year

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May we contact for reference? *

Yes
No
Later

2nd Most Recent Employer

Company Name

Most Recent Employer

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Starting Job Title

Final Job Title

Immediate Supervisor and Title (for most recent position held)

Why did you leave?

Dates employed:

[br] [br]

May we contact for reference?

Yes
No
Later

[hr] [br]

3rd Most Recent Employer

Company Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Starting Job Title

Final Job Title

Immediate Supervisor and Title (for most recent position held)

Why did you leave?

Dates employed:

May we contact for reference? (copy)

Yes
No
Later

[hr]

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Skills and Qualifications

Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying: *

Summarize any Computer Skills that may assist you in performing the position for which you are applying: *

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Educational Background

Starting with your most recent school attended, provide the following information

School (include City & State) *

Years Completed *

Received *

Diploma
Degree
GED
Certification

GPA Class Rank

Major/Minor

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2nd most recent School (include City & State)

Years Completed

Received

Diploma
Degree
GED
Certification

GPA Class Rank

Major/Minor

3rd most recent School (include City & State)

Years Completed

Received

Diploma
Degree
GED
Certification

GPA Class Rank

Major/Minor

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References

List names and telephone numbers of two business/work references who are not related to you and are not previous supervisors and one personal reference who is not related to you.

Reference #1 Name *

Title *

Relationship To you *

Telephone *

E-mail

# of Years Known *

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Reference #2 Name *

Title *

Relationship To you *

Telephone *

E-mail

# of Years Known *

[hr]

Reference #3 Name *

Title *

Relationship To you *

Telephone *

E-mail

# of Years Known *

Please Upload a copy of your Drivers License *

Click or drag a file to this area to upload.

Applicant Statement [br]

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct. [br] [br]

I expressly authorize, without reservation, 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 furnishing such information about me.[br] [br] I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating an applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.[br] [br] If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice , and the employer reserves the same right to terminate my employment for any lawful reason with or without cause and with or without prior notice. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language and valid unless they are in writing and signed by the employer’s president.[br] [br] I 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.[br] [br] Community Quest, Inc. will request a background check, containing background information about you in connection with your employment, or application for employment, or engagement for services (including independent contractor or volunteer assignments, as applicable).[br] [br] A third party company will prepare or assemble the background report for Community Quest, Inc.. The background report(s) may contain information concerning your character, general reputation, personal characteristics, mode of living, or credit standing. The types of background information that may be obtained include, but are not limited to: criminal history; litigation history; motor vehicle record and accident history; social security number verifications; address and alias history; credit history; verifications of your educations, employment and earnings history; professional licensing; credential and certification checks; drug/alcohol testing results and history; military service; and other information. I hereby authorize Community Quest, Inc. to obtain the consumer reports described.[br] [br] 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 eliminate me from further consideration for employment, or may result in my immediate discharge from the employer’s service, whenever it is discovered.[br] [br]

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT. I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement. I understand that by entering my name below, this will act as my signature on this document.

Certify *

Yes
No

Name *

First

Middle

Last

Date