Employment Application Application Name(Required) First Last Email(Required) Home PhoneCell PhonePresent Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code How long have you lived at this address?(Required)Date on Which You Can Start(Required) MM slash DD slash YYYY List previous address if you have lived at current address less than two years:Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?(Required) Yes No Have you ever applied to this organization before?(Required) Yes No If Yes, when did you apply? MM slash DD slash YYYY Criminal HistoryWithin the past ten (10) years, have you been convicted of a felony? (Do not include convictions that were sealed, eradicated, erased, or expunged; convictions that resulted in referral to a diversion program; or marijuana-related convictions that are more than two (2) years old.)(Required) Yes No NOTE • Criminal convictions will not automatically disqualify an applicant from a particular job. The Company will consider the nature of the crime, its seriousness, whether the conviction(s) substantially relates to the position’s functions and qualifications, the frequency of convictions, the applicant’s age at the time of conviction, the time elapsed since the date of conviction or completion of jail sentence, the applicant’s entire work and educational history, and employment references and recommendations. • An ex-offender who is denied employment may, upon written request, receive a statement of the reason(s) for denial within 30 days of the applicant’s request for such information. If Yes, please explainIf Yes, please explain so that individual circumstances can be considered. (A Yes answer will not necessarily disqualify you from employment.) Have you ever initiated an act of violence in the workplace?(Required) Yes No If Yes, please explainEducation and ExperienceWhat is your educational experience (select all that apply)?(Required) High School Technical School/Community College College/University Graduate School What High School did you attend?City and State of High School?# of years completedDid you graduate? Yes No Date of Graduation MM slash DD slash YYYY What Tech/Trade School or Community College did you attend?Course of StudyCity and State of Tech School/Community College?# of years completedDid you graduate? Yes No Date of Graduation MM slash DD slash YYYY Degree or Certification earnedWhat College/University did you attend?City and State of College/University?Course of Study# of years completedDid you graduate? Yes No Date of Graduation MM slash DD slash YYYY Degree earnedWhat graduate school did you attend?City and State of Graduate School?Course of Study# of years completedDid you graduate? Yes No Date of Graduation MM slash DD slash YYYY Degree earnedList any honors you received in your educational historyTechnical SkillsList special technical skills that you feel qualify you for the job for which you are applying (i.e., computer programming/language, software, equipment operation, special tools or machines, etc.)How did you hear about Communities In Schools Chatham County?Please list any professional licenses and/or membershipsREFERENCESList three references (not relatives) who have known you for at least one year. At least two references need to be related to previous employment.Reference #1Name(Required) First Last Relationship to you(Required)(i.e. supervisor, co-worker, etc.)Company(Required)Position(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone(Required)Email(Required) Reference #2Name(Required) First Last Relationship to you(Required)(i.e. supervisor, co-worker, etc.)Company(Required)Position(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone(Required)Email(Required)Reference #3Name(Required) First Last Relationship to you(Required)(i.e. supervisor, co-worker, etc.)Company(Required)Position(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone(Required)Email(Required)Please upload a copy of your cover letter(Required)Max. file size: 300 MB.Please upload a copy of your resume(Required)Max. file size: 300 MB.Consent(Required) I agree.I understand and agree that if driving is a requirement of the job for which I am applying, my employment and/or continued employment is contingent on possessing a valid driver’s license and automobile liability insurance in an amount equal to the minimum required by the state where I reside. I understand that the Company may now have, or may establish, a drug-free workplace or drug and/or alcohol testing program consistent with applicable federal, state, and local law. If the Company has such a program and I am offered a conditional offer of employment, I understand that if a pre-employment (post-offer) drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug-free workplace, consistent with applicable federal, state, and local law. I also understand that all employees of the location, pursuant to the Company’s policy and federal, state, and local law, may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or controlled drugs. If employed, I understand that the taking of alcohol and/or drug tests is a condition of continual employment and I agree to undergo alcohol and drug testing consistent with the Company’s policies and applicable federal, state, and local law. If employed by the Company, I understand and agree that the Company, to the extent permitted by federal, state, and local law, may exercise its right, without prior warning or notice, to conduct investigations of property (including, but not limited to, files, lockers, desks, vehicles, and computers) and, in certain circumstances, my personal property. I understand and agree that as a condition of employment and to the extent permitted by federal, state, and local law, I may be required to sign a confidentiality, non-compete, and/or conflict of interest statement. I certify that all the information on this application, my résumé, or any supporting documents is complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal. I UNDERSTAND THAT NEITHER THIS APPLICATION NOR ANY COMMUNICATION BY A MANAGEMENT REPRESENTATIVE IS INTENDED TO CREATE OR DOES CREATE A CONTRACT OF EMPLOYMENT, OFFER, OR PROMISE OF EMPLOYMENT. I ACKNOWLEDGE THAT IF HIRED BY THE COMPANY, EMPLOYMENT IS ON AN AT WILL BASIS. THIS MEANS THE COMPANY IS FREE TO TERMINATE MY EMPLOYMENT AT ANY TIME, WITH OR WITHOUT CAUSE OR ADVANCE NOTICE, IN ACCORDANCE WITH STATE LAW, AND ACCEPTANCE OF EMPLOYMENT IS NOT A CONTRACT OF EMPLOYMENT FOR ANY SPECIFIED TIME. SIMILARLY, I AM FREE TO TERMINATE MY EMPLOYMENT WITH THE COMPANY AT ANY TIME FOR ANY REASON. THIS AT-WILL PROVISION MAY BE MODIFIED OR WAIVED ONLY IN A WRITTEN AGREEMENT SIGNED BY AN AUTHORIZED REPRESENTATIVE OF THE COMPANY AND ME. I AGREE TO CONFORM TO THE RULES AND REGULATIONS OF THE COMPANY, AND I UNDERSTAND THAT THE COMPANY HAS COMPLETE DISCRETION TO MODIFY SUCH RULES AND REGULATIONS AT ANY TIME, EXCEPT THAT IT WILL NOT MODIFY ITS POLICY OF EMPLOYMENT AT-WILL. I authorize the Company or its agents to confirm all statements contained in this application and/or résumé as it relates to the position I am seeking and to the extent permitted by federal, state, or local law. I agree to complete any requisite authorization forms for the background investigation. I authorize and consent to, without reservation, any party or agency contacted by this employer to furnish the above-mentioned information. I hereby release, discharge and hold harmless, to the extent permitted by federal, state, and local law, any party delivering information to the Company or its duly authorized representative pursuant to this authorization from any liability, claims, charges, or causes of action which I may have as a result of the delivery or disclosure of the above requested information. I hereby release from liability the Company and its representative for seeking such information and all other persons, corporations, or organizations furnishing such information. If hired by this Company, I understand that I will be required to provide genuine documentation establishing my identity and eligibility to be legally employed in the United States. I also understand this Company employs only individuals who are legally eligible to work in the United States. CAPTCHA
