Application for Employment

BIG FIVE COMMUNITY SERVICES, INC

(A Community Action Agency)

We consider applications 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.

A SEPARATE APPLICATION MUST BE COMPLETED FOR EACH POSITION APPLIED FOR

Today's Date(Required)

Name(Required)

First Middle Last

Social Security #(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Home Phone #

Cell Phone #

E-mail Address

Driver License #(Required)

Driver License State(Required)

Commercial Driver License

Yes

List any other names used if different from name on this application. (N/A if not applicable.)

Have you ever been convicted of a felony or subjected to a deferred adjudication of a felony charge, including a plea of no contest?(Required)

Yes

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.(Required)

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.(Required)

Type of Employment Desired

Full-Time

Part-Time

Summer

Date Available To Begin Work?

Desired Salary Range

What Days Are You Available To Work?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

What hours are you available to work?

Are You Currently Employed?

Yes

If you are under 18, and it is required, can you furnish work permit?

Yes

Are you a citizen of the United States?(Required)

Yes

If no, are you authorized to work in the United States?(Required)

Yes

Have you ever worked for this agency?

Yes

If so, when did you work for our agency?(Required)

Do any of your relatives work for this Company or serve on the board?

Yes

Relative Names and Relationship(Required)

Education

High School

High School Address

Did you graduate (high school)?

Yes

High School Completion Date

College or University

College Address

Did you graduate from college?(Required)

Yes

Degree: Major/minor

College Graduation Date

Business/Trade/Technical School

Business School Address

Business School - did you graduate?

Yes

Certification

Other Education

Other Education Address

Other Education Years Completed

Other Education 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.

Previous Employer

Company	Job Title	Start Date	End Date	Actions

There are no Previous Employers.

References

Give at least three references other than relatives or supervisors listed above.

References

Reference Name	Reference Phone	Reference Relationship	Actions

There are no References.

Resume

Attach Resume

Max. file size: 512 MB.

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.(Required)

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.(Required)

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.(Required)

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.(Required)

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.(Required)

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.(Required)

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.(Required)

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.(Required)

Complete Your Application

AN EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION EMPLOYER

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Application for Employment