NICHOLAS COMMUNITY ACTION PARTNERSHIP, INC. - Application for Employment

AN EQUAL OPPORTUNITY EMPLOYER

Nicholas CAP considers qualified applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a medical condition or disability that can be reasonably accommodated, or any other legally protected status. Questions on this application are not used for the purpose of limiting or excusing any applicant for consideration of employment. The fact that this application has been provided to you does not necessarily mean there are positions available and does not in any way obligate Nicholas CAP to offer you employment.

INSTRUCTIONS - Each question/part must be fully and accurately completed. Further consideration may not be given until all questions/parts have been completed.

Your Name

First Last

List the Job Position/Title for which you are applying:(Required)

Type of Employment for which you are applying:

Full-Time

Part-Time

Temporary

Department for which you are applying:

Weatherization

Senior Programs

Head Start

Administrative

Referral Source:

Internet Ad

NCAP Website

Newspaper Ad

NCAP Employee

Other:

(BEGIN WITH YOUR CURRENT OR MOST RECENT EMPLOYER, ASSIGNMENT'S OR VOLUNTEER ACTIVITIES)

APPLICANT INFORMATION

Your Name(Required)

First Middle Last

Other name(s) used that would help us check your work history/education:

Phone(Required)

Cell Phone

Email Address(Required)

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Are you legally eligible for employment in the United States? (proof will be required upon employment)(Required)

Yes

Have you ever applied for a position at NCAP?(Required)

Yes

If yes, when:

Have you ever been employed by NCAP?(Required)

Yes

If yes, when:

Do you have any relatives employed at NCAP?(Required)

Yes

If yes, who:

If hired, when can you be available for work?(Required)

What is your desired salary?(Required)

Are you able to meet attendance requirements for this position?(Required)

Yes

Do you have a valid driver’s license? (if driving is an essential job function):(Required)

Yes

State Issued:

If required, will you undergo a post-offer physical examination?(Required)

Yes

Have you been convicted of, or pled guilty, no contest to, or been convicted of a felony?(Required)

Yes

If yes, list what type, the date of conviction, the county and state the violation was committed in and the sentence and the current status:

EMPLOYMENT HISTORY

Applications are kept in active status for sixty (60) days.

Your Previous Employers

Please list your previous employers, the dates you worked and the position you held.

Employer

Dates

Position

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do we have permission to contact this Company?

Yes

Pay Rate:

Hour

Annual

Starting $

Ending $

Your last immediate supervisor is/was:

Phone Number:

Reason for leaving (or why you are looking to leave if still employed):

EMPLOYMENT HISTORY CONTINUED

Your Previous Employers

Please list your previous employers, the dates you worked and the position you held

Employer

Dates

Position

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do we have permission to contact this Company?

Yes

Pay Rate:

Hour

Annual

Starting $

Ending $

Your last immediate supervisor is/was:

Phone Number:

Reason for leaving (or why you are looking to leave if still employed):

UNITED STATES MILITARY HISTORY

Were you in the Armed Services:

Yes

If Yes, what branch?

Dates of Service:

From

MM slash DD slash YYYY

Dates of Service:

MM slash DD slash YYYY

Honorable Discharge?

Yes

Please detail what job experience you gained there:

EDUCATION

High School(Required)

School Name

Course of Study

# Years Completed

Degree

Yes

College(Required)

School Name

Course of Study

# Years Completed

Degree

Yes

Other

School Name

Course of Study

# Years Completed

Degree

Yes

OTHER TRAINING, LICENSURE/CERTIFICATION AND EXPERIENCE

List any special training, licensure/certification and/or experience that may qualify you to perform job-related functions in the position for which you are applying:

PROFESSIONAL REFERENCES

Please list two (2) or more supervisor references (not relatives) who are familiar with your job performance.(Required)

Name:

Phone Number:

Years known:

Second Required Supervisor Reference:

Name:

Phone Number:

Years known:

Please list two (2) or more supervisor references (not relatives) who are familiar with your job performance.

Name:

Phone Number:

Years known:

APPLICANT STATEMENT
SIGN YOUR NAME AND PUT THE DATE ON THE BOTTOM OF THIS PAGE. If you fail to comply with these instructions, you may not be considered for employment.

APPLICANT STATEMENT

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (I) cancel further consideration of this application, or (II) immediately discharge me from the employer’s service, whenever it is discovered.

I expressly authorize Nicholas Community Action Partnership, Inc. its representatives, employees or agents to contact and obtain information from all references (personal and professional) employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I authorize Nicholas CAP, Inc to obtain consumer reporting information about me from other sources, for the purpose of considering me for employment. This may include information about my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, work habits, job performance, experience and reasons for leaving other employment, as well as other public records such as any criminal records. I hereby waive any and all rights and claims I may have regarding Nicholas CAP, Inc., its agents, employees or representatives, for seeking, gathering, and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that NCAP, Inc. does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant for consideration for employment on a basis prohibited by applicable local, state, or federal law.

I understand that this application remains current for only 60 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

I understand that the position for which I am applying constitutes an at-will employment and that just as I am free to resign at any time, Nicholas CAP, Inc. reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the Employer has the authority to make any assurances to the contrary.

I Certify that I have read, fully understand, and accept all terms of the forgoing Applicant Statement.

By submitting this application electronically you are attesting that all information is true and accurate.

Signature

You are consenting that your typed name will be your signature.

Date

MM slash DD slash YYYY

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