Job Application

Legal Name*

First Last

Current Name

Pronouns*

Present Address

Street Address City State ZIP Code

Email*

Phone*

Alternate Phone

Are you 18 years of age or older?*

Yes

Are you legally eligible for employment in the U.S.?*

Yes

Any restrictions that would prohibit you from performing certain jobs or duties?*

Yes

If yes, please describe in full.

Have you ever been convicted of a crime?*

Yes

If yes, please describe in full.

education

Education History

Type of School	Name of School	Location	Years Completed	Major and Degree (if applicable)	Actions

There are no Schools.

desired employment

Position Applying For*

Type of Employment Desired*

Full-time

Part-time

Temporary

Area of Interest

Days Available to Work*

Are There Hours You Cannot Work?

Salary Desired

Date Available to Begin Work

Have You Ever Applied with CSA Before?*

Yes

If Yes, When:

Were You Interviewed?

Yes

List any additional skills and knowledge that relates to your ability to perform the job for which you are applying (such as license, professional memberships, computer skills, and special interest):

List any job-related information that you feel may help us in considering you for the position you are applying. (Examples: What are your career expectations? What can you contribute to a company? Have you held positions in the community you feel have transferable skills?)

employment history

Please list all work experience starting with your most current employer.

Job History

Employer	Position/Title Held	Start Date	End Date	Actions

There are no Jobs.

references

List three people not related to you whom you have known at least one year. At least two of them should be professional references.

References

Name	Relationship	Years Known	Phone	Actions

There are no References.

Equal Opportunity Employment

CSA is dedicated to providing equal employment and advancement opportunities. It is our policy to provide equal employment opportunities to all individuals based upon job-related qualifications, and the requirements of each position, without regard to age, sex, pregnancy, race, color, religion, creed, national origin, disability, sexual orientation, gender identity, genetic information, military service, or any other legally-protected characteristic, and to maintain an environment free from harassment based upon these grounds.

authorization

Please read and understand this statement before signing your application.

I certify that the facts contained in this application are true and complete to the best of my knowledge. I further understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein. I release from any and all liability all the references and employers listed above who provide information concerning my previous employment and any other information, personal or otherwise, to Community Support Advocates.

This application will expire in 6 months. After that date, I understand that my status as an applicant will end. I may re-apply for employment in the future by completing a new application.

This application is not an employment agreement. If I accept an offer of employment, I understand that the employer or employee may terminate such employment at any time, with or without cause and without prior notice, unless required by law. I understand that no one, other than an Executive Director of the employer, has the authority to enter into an employment agreement with terms contrary to the foregoing and then only in writing signed by such director.

I fully understand and accept all terms and conditions in the above listed statement.

Signature*