Application For Employment

We consider applications for all positions without regard to race, color, religion, creed, sex, national origin, disability, sexual orientation, citizenship status or any other legally protected status. We are an equal opportunity employer!

Position(s) Applied For

Date of Application

How Did You Learn About Us?

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Relative
Inquiry
Employment Agency
Friend
Other

Last Name

First name

Middle Name

Street Address, City, State, Zip

Telephone Numbers

Best time to contact you at home is: (Please indicate AM or PM)

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

Yes
No

Have you ever filed an application with us before?

Yes
No

If Yes, give date

Have your ever been employed with us before?

Yes
No

If Yes, give date

Do any of your friends or relatives, other than spouse, work here?

Yes
No

Are you currently employed?

Yes
No

May we contact your present employer?

Yes
No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment.

Yes
No

Date available for work?

What is your desired salary range?

Are you available to work:

Select All
Full-Time
Part-Time
Temporary

If you selected Full-Time, please indicate if you are available for:

1st Shift
2nd Shift
3rd Shift

If you selected Part-Time, please indicate if you are available for:

Mornings
Afternoon
Evenings

If you selected Temporary, please indicate dates available:

Are you currently on "lay-off" status and subject to recall?

Yes
No

Can you travel if the job requires it?

Yes
No

Education

List your Elementary School Name and Address, Course of Study, Number of Years Completed and Diploma/Degree:

List your High School Name and Address, Course of Study, Number of Years Completed and Diploma/Degree:

List your Undergraduate College Name and Address, Course of Study, Number of Years Completed and Diploma/Degree:

List your Graduate Professional Name and Address, Course of Study, Number of Years Completed and Diploma/Degree:

Other - Please Specify School Name and Address, Course of Study, Number of Years Completed and Diploma/Degree:

Describe any specialized training, apprenticeship, skills and extra-curricular activities:

Describe any job-related training received in the United States Military:

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer 1 - List Employer Name, Address, Phone Number(s), Job Title, Supervisor and Reason for leaving:

List dates employed, work performed and starting and final hourly rate/salary.

Employer 2 - List Employer Name, Address, Phone Number(s), Job Title, Supervisor and Reason for leaving:

List dates employed, work performed and starting and final hourly rate/salary.

Employer 3 - List Employer Name, Address, Phone Number(s), Job Title, Supervisor and Reason for leaving:

List dates employed, work performed and starting and final hourly rate/salary.

Employer 4 - List Employer Name, Address, Phone Number(s), Job Title, Supervisor and Reason for leaving:

List dates employed, work performed and starting and final hourly rate/salary.

List professional, trade, business or civic activities and offices held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability, or other protected status:

Additional Information

Other Qualifications - Summarize special job-related skills and qualifications acquired from employment or other experience:

Specialized Skills (Check Skills/Equipment Operated)

Terminal
PC/Mac
Typewriter
Spreadsheet
Word Processing
Shorthand

What is your WPM?

List any Production/Mobile Machinery or Skills:

State any additional information you feel may be helpful to us in considering your application.

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN GIVEN INFORMATION ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Can you perform the essential functions of the job, for which you are applying, either with or without a reasonable accommodation?

Yes
No

References

Reference 1: List Name, Address, and Phone Number.

Reference 2: List Name, Address, and Phone Number.

Reference 3: List Name, Address, and Phone Number.

Applicant's Statement

I certify that answers given herein are true and complete. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

Print your Name if you agree to the Applicant's Statement. By typing your name in the box, you agree this to be the equivalent of your signature.

Date

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PRIDE is part of the Community Action Partnership which is an alliance of nonprofit private and public organizations established under the Economic Opportunity Act of 1964 to fight America's War on Poverty. Community Action Agencies help people to help themselves in achieving economic security.

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Application For Employment

Education

Employment Experience

Additional Information

References

Applicant's Statement

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