Job Application

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About You

Your Name(Required)

First Last

Your Address

Street Address Address Line 2 City ZIP Code

How Can We Reach You?

Your Phone(Required)

Your Email Address

Position Desired

Shift Preference

Social Services affliation?(Required)

Are you or your spouse an official or employee of the Department of Health & Human Services or of any county department of social services or a member of the Social Services Commission, of any county board or social services, or of any board of county commission or of any advocacy groups?

Yes

Education and Work History

What is the highest grade you completed?(Required)

Please enter a number from 1 to 18.

Please list the high schools, colleges, universities, graduate schools or vocational schools that you have attended. Please also list the dates attended and if you are a graduate of that school.

Please list your work history (including volunteer experience).

Employer, Address, Job title, Supervisor's name, position, reason for leaving, date separated, dates employed.

Are you involved in any trade or personal organization. If so, please list.

Are you licensed, certified or registered in any profession? If so, please list your certification number.

Have you ever been convicted of any criminal or driving offense, other than a minor traffic violation?(Required)

If yes, written documentation must be provided about the criminal offenses from the clerk of court in the county in which the conviction was made, and about any driving offenses other than minor traffic violations from the motor vehicles office.

Yes

References(Required)

You must provide at least three current reference letters and/or the name of individuals with whom a reference interview can be conducted. Please list the full name, mailing address, and phone number of three references who have knowledge of you and your qualifications in the field.

Please attach your resume.

Max. file size: 64 MB.

Certification(Required)

I agree to carry out the designated responsibilities to the best of my ability. I have read the position description. I am aware there is a conditional period of 3 months prior to permanent employment. I certify that I have given true, accurate, and complete information on this form to the best of my knowledge. I authorize investigation of statements made in the application and understand that false information may be grounds for denial of my position and/or dismissal, if I am employed.

Yes

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