Please Fill Out The Form Below
Reaquired field: Last Name:
Reaquired field: First Name:
Reaquired field: Middle Name:
Reaquired field: Social Security #:
Reaquired field: Street Address:
Reaquired field: Apartment/Unit #:
Reaquired field: City:
Reaquired field: State:
Reaquired field: Zip:
E-mail Address:
Reaquired field: Driver License #:
Reaquired field: Driver License State:
Reaquired field: List any other names used if different from name on this application. (N/A if not applicable.)
If your answer was "Yes" explain in concise detail giving the dates and nature of the offense, the name and location of the court, and the disposition of the case(s). Due to the requirements of our government funding agents, any felony conviction may disqualify you from employment with Big Five.
Reaquired field: List exact location and title of position for which you wish to apply. Application is incomplete and will not be considered if this area is left blank.
Date available to begin work?
Desired Salary Range?
What hours are you available to work?
Are you currently employed?
If you are under 18, and it is required, can you furnish work permit?
If no, are you authorized to work in the United States?
Have you ever worked for this agency?
If so, when?
If yes, list names and relationship?
EDUCATION
High School
Address of High School
Did you graduate?
Date Completed:
College or University:
Address of College or University:
Reaquired field: Did you graduate?
Degree: Major/Minor
Business/Trade/Technical School:
Address:
Did you graduate?
Certification:
Other:
Address:
Years Completed:
Degree:
Describe any specialized training, apprenticeships.
PREVIOUS EMPLOYMENT: Please give accurate, complete full-time and part-time employment record. Begin with your present or most recent employer.
Company:
Address:
Name of Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
Start Date:
End Date: (N/A if still employed)
Reason for Leaving:
Company:
Address
Name of Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
Start Date:
End Date:
Reason for Leaving:
Company:
Address:
Name of Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
Start Date:
End Date:
Reason for Leaving:
Company:
Address:
Name of Suprevisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
Start Date:
End Date:
Reason for Leaving:
Give at least three references other than relatives or supervisors listed above.
Name:
Organization:
Relationship:
Known how long?
Name:
Organization:
Relationship:
Known how long?
Name:
Organization:
Relationship:
Known how long?
APPLICANT'S STATEMENT AND SIGNATURE
Please read and initial each statement.
I certify that all the information provided by me in connection with my application, whether on this document or not, is true and complete, and I understand that any misstatement, falsification, or omission of information shall be grounds for refusal to hire, or if hired, for immediate termination.
I understand that this application is considered current only during the period that the current job opening exists. To be considered for later employment a new application must be submitted in person and in writing when a job for which you wish to be considered is advertised. I understand that if I am selected for employment additional information may be required by state or federal laws or regulations. I understand that compliance with the agency's Personnel Policies and Prodedures and the agency's Drug Free Work Place and Testing Policy are conditions of continued employment.
I understand that if hired, my employment would be an at-will relationship, which means it could be terminated, with or without notice at any time, by me or by my employer, for any reason or for no reason at all, but not for an illegal reason.
I also certify that no supervisor, manager, or representative of the Company, has made promises to me that would create a contract between the Company and me, or has made promises that would in any way alter the at-will relationship.
I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information that they might have, personal or otherwise, with regard to any other subjects covered by this application, and I release all such parties from all liability from any damages which may result from furnishing such information to you.
I understand that Big Five Community Services, Inc. does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.
I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete a I-9 Form in this regard.
I understand that I may be offered employment, conditional upon satisfactory completion of a thorough background investigation and/or drug screen. If offered employment with Big Five Community Services, Inc., I agree to participate in this process. I also understand that refusal to participate in any part of the background investigation process may result in disqualification from consideration or employment or withdrawal of a conditional offer if one has been made.
AN EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION EMPLOYER
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