Application for Employment | The Crisis Center of Grand Island

Application for Employment

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, martial or veteran status, or any other legally protected status. We are an equal opportunity employer.

Position Applying for.: *

How Did You Learn About Us?: *

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Friend

Employment Agency

None of the Above.

Name

First Name: *

Please Enter your first Name.

Middle Initial: *

Please enter your middle initial

Last Name: *

Please Enter your last name

Address

Please enter your address below:

Street Address: *

Please enter your street address including apt or house number.

Phone number:

City: *

State: *

Please enter your current state of residence.

Zip Code: *

Best time to contact you.*

:

am

pm

Have you ever filed an application with us before? Yes or No, if yes please state date of when.: *

Date you wil be available for work?*

Are you currently employed: *

Yes

No

Desired Salary Range?: *

Do you have a valid Drivers License?:

Yes

No

DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE POSITION YOU ARE APPLYING FOR!:

Yes

No

Are you capable of performing in a reasonable manner, the activited involed in the occupation yo have applied for?

Education

Highschool

School Name:

Address:

Course of Study:

Number of years completed.:

Diploma or Degree:

College

School Name:

Address:

Course of Study:

Number of years completed.:

Diploma or Degree:

Graduate

School Name:

Course of Study:

Number of years completed.:

Diploma or Degree:

Business or Trade School

School Name:

Course of Study:

Number of years completed.:

Diploma or Degree:

Work Experience

Most Recent Employer

Employer Name:

Dates Employed:

Please enter the dates you wered employed from begining month and year to end month and year.

Work Performed:

Phone Number(s):

Employer Address:

Starting/Present Job Title:

Please enter your job title of when you started and your present or ending title.

Hourly Rate:

Please enter your hourly rate of when you started and your current or ending hourly rate.

Supervisor:

Reason for Leaving:

May we contact?:

Yes

No

Previous Employer

Employer Name:

Dates Employed:

Work Performed:

Employer Address:

Phone Number(s):

Starting/Present Job Title:

Please enter your job title of when you started and your present or ending title.

Hourly Rate:

Please enter your hourly rate of when you started and your current or ending hourly rate.

Supervisor:

Reason for Leaving:

May we contact?:

Yes

No

Explain any gaps you may have in your employment.:

What types of equipment cna you operate and do you have any special skills.(such as computer programs):

Any Specialized training,skills and extra curricalar activities? (You may exclude what that reveal any protected status):

In the space below, state why you desire a position in this company and why you think you would be a valuable employee.:

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 arrving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 90 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applicatios are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise deined 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 unless such change specifically ackknowleged in writing by an authorized executive of this organization.

In the even 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 regulation of the employer.

Submission of this Form will count as your signature to the agreement of the above statement.