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A photographic series
Community Engagement Coordinator/SDNC – Employment Application
APPLICANT INFORMATION
Name
*
First
Middle Initial
Last
Home Phone
*
Cell Phone
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email Address
*
Referred by
*
Are you 18 years old or older?
*
Yes
No
Are you an AmeriCorps, Peace Corps, or National Service alum?
*
Yes
No
Do you or any of your immediate family members conduct business with our agency? Business transactions include, but are not limited to, contracts of sale, lease, license and performance of services.
*
Yes
No
If you answered "yes" above, please explain.
What is your hourly salary expectation?
*
Do you have a valid driver's license?
*
Yes
No
(may be a job requirement)
Are you willing to work overtime if necessary?
*
Yes
No
Are you willing to work weekends?
*
Yes
No
Is there anything that would prevent you from performing in a reasonable and safe manner the activities involved in the position for which you have applied?
*
Yes
No
If you answered "Yes" above, please explain.
Do you have any relatives who are employed with our agency? If so, please list their name(s) here.
*
(otherwise, type N/A)
Are you currently authorized to work for all employers in the United States on a full-time basis, or only for your current employer?
*
All employers
Current employer only
Federal laws require the hiring of individuals who are authorized to be lawfully employed in the U.S. In compliance with such laws, FPWC will verify the status of every individual offered employment with our agency. All offers of employment are subject to verification of the applicant's identity and employment authorization, and it will be necessary for you to submit such documents as required by law to verify your identification and employment authorization.
EDUCATION
Name of High School or GED, and location:
*
(for example, South High School, Garland, TX)
Did you graduate?
*
Yes
No
Name of College and location:
*
(for example, Univ. of Texas, Austin, TX; otherwise type N/A)
Did you graduate?
*
Yes
No
Degree and fields of study:
*
Please list any other licenses/certifications/training applicable to this position:
EMPLOYMENT EXPERIENCE
Are you currently employed?
*
Yes
No
Employment Experience #1
*
Employer
(List current employment first. If not currently employed, list the last place you worked)
*
Employer Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Title and responsibilities:
*
This position was:
*
Full time
Part time
Seasonal
Employed from/to:
*
(approximate dates)
Reason for leaving:
*
Supervisor name and title:
*
Supervisor phone and e-mail address:
*
May we contact this supervisor for a reference?
*
Yes
No
Employment Experience #2
*
Employer
*
Employer Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Title and responsibilities:
*
This position was:
*
Full time
Part time
Seasonal
Employed from/to:
*
(approximate dates)
Reason for leaving:
*
Supervisor name and title:
*
Supervisor phone and e-mail address:
*
May we contact this supervisor for a reference?
*
Yes
No
Employment Experience #3
*
Employer
Employer Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Title and responsibilities:
This position was:
Full time
Part time
Seasonal
Employed from/to:
(approximate dates)
Reason for leaving:
Supervisor name and title:
Supervisor phone and e-mail address:
May we contact this supervisor for a reference?
Yes
No
MILITARY SERVICE
Have you ever served in the U.S. Armed Forces? If so, list service duties, including special training relevant to the position for which you applied:
PROFESSIONAL REFERENCES
List three (3) PROFESSIONAL references:
*
(include name, company, title, telephone, e-mail address, and your professional relationship with them).
DISCLAIMER AND SIGNATURE
PRE-EMPLOYMENT STATEMENT (please read very carefully before signing below): I understand and voluntarily agree that the information I have provided on this application is true and complete to the best of my knowledge. Any misrepresentation or omission of any fact in my application, resume, or any other materials, or during any interviews, can be justification for refusal of employment, or if employed, termination from FPWC's employ. Any offer of employment I may receive is contingent upon my successful completion of the total pre-employment screening process, including FPWC receiving references that it considers satisfactory, and my satisfactory completion of any post offer medical examination that the agency may require. I understand that as a condition of employment, I will be required to undergo and successfully pass a screening for alcohol/drugs. I also understand and agree that, if employed, I will be required to submit to an alcohol/drug screening at any time at the discretion of FPWC. In processing my application for employment, FPWC may verify all the information provided by me, including my prior employment, military records, education, criminal and driving record. I authorize and request that all of my present/former employers and those individuals I have listed as references furnish information about my employment record, including a statement of the reason for the termination of my employment, work performance, abilities, and other qualities pertinent to my qualifications for employment, hereby releasing them from any and all liability for damages arising from furnishing the requested information. In consideration of my employment, I agree to comply with the policies, rules, regulations and procedures of FPWC and understand that my employment and compensation can be terminated with or without cause or notice, at any time, at the option of the either the agency or myself.
My on-line signature shall substitute for and have the same legal effect as an original form signature (type your legal name)
*
SCROLL DOWN AND PRESS "SUBMIT" TO SEND YOUR APPLICATION.
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