1.800.798.6565 

Application
Applicant Information
Position applied for Date of application
Last Name First Name Middle Name
Maiden Name Alias
Marital Status
Street Address
City, State, Zip
Telephone Number Mobile Number
Social Security Number      
If you are 18, and it is required, can you furnish a work permit?
If no, please explain
Have you ever been employed here before? If yes, when?
Are you legally eligible for employment in this country? Date available
Type of employment desired
Are you able to meet the attendence requirements of the position?
Have you ever been convicted of a crime?
If yes, please explain

Conviction will not necessarily be a bar to employment. Each instance will be considered in relation to the position for which you are applying.

Divers license number State Expiration date
EMERGENCY CONTACTS
Spouse: Name Phone Number
Other: Name Phone Number
Other: Name Phone Number


Availability

Do you have reliable transportation?

WHAT SCHEDULE CAN YOU WORK? (What is the earliest that you can go into work and what is the latest you can stay? This will help us in locating a client with hours you can work.)

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Check the box next to any parish in which you are available to work




Employment History
Provide the following information for your past four (4) employers, assignments or volunteer activities, STARTING with the most recent.
Name of Employer
Dates of Employment From To
Phone
Address
Job Title
Job Responsibilities
Supervisor and Title
Reason(s) for Leaving
Hourly rate/salary Starting Final

Employer 2
Name of Employer
Dates of Employment From To
Phone
Address
Job Title
Job Responsibilities
Supervisor and Title
Reason(s) for Leaving
Hourly rate/salary Starting Final

Employer 3
Name of Employer
Dates of Employment From To
Phone
Address
Job Title
Job Responsibilities
Supervisor and Title
Reason(s) for Leaving
Hourly rate/salary Starting Final

Employer 4
Name of Employer
Dates of Employment From To
Phone
Address
Job Title
Job Responsibilities
Supervisor and Title
Reason(s) for Leaving
Hourly rate/salary Starting Final
Skills and Qualifications
Summarize any training, skills, licenses, and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.
Educational Background
High School
Name and Location
Years Completed Did you graduate?
Course of Study
College
Name and Location
Years Completed Did you graduate?
Course of Study
Other Education
Name and Location
Years Completed Did you graduate?
Course of Study
References

Please do not list family members as references

Reference 1
Name
Telephone Years Aquainted
Reference 2
Name
Telephone Years Aquainted
Reference 3
Name
Telephone Years Aquainted



If you were referred to CARE Inc, please tell us who referred you.


Referred by:
Referrer's Phone Number



I understand that if I am employed, any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate discharge from the employer's service whenever it is discovered.

I give the employer the right to contact and obtain information from all references, employers, and educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from all liability the employer and it's representatives for seeking, gathering and using such information and all other persons, corporations and organizations for furnishing such information.

The employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state or federal law.

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

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no representative of the employer other than an authorized officer has the authority to make any assurances to the contrary. I further understand that any such assurances must be in writing and signed by an authorized officer.

I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization.

I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.


NOTE: Check entire form to be sure no questions have been omitted. If the question does not apply to you, please mark n/a (not applicable.)


Digital Signature:
(type your complete name)
Date:
Office Addresses

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