Easter Seals Iowa Application for Employment

Transcription

1 Easter Seals Iowa Application for Employment PERSONAL DATA Name Permanent Address City, State, Zip Current Address City, State, Zip Address Permanent Phone Number ()Current Phone Number () Social Security Number Driver s License State Have you previously been employed here? No Yes If yes, when position Have you previously applied here? No Yes If yes, when? Do you know anyone currently employed by us? No Yes If yes, who and relationship Referral Source: Career Builder Other Social Media: College Website: ISU Grandview Drake Simpson Central DMACC Position desired: 1 st choice 2 nd choice If applying for seasonal or temporary employment indicate dates available: to Are you age 18 or older? If not, please indicate date of birth: EDUCATION MAJOR/ YEAR DEGREE or SCHOOL NAME MINOR COMPLETED DIPLOMA REC D GRADUATE COLLEGE BUSINESS, TRADE, OR TECHNICAL HIGH SCHOOL XXXXXX

2 EMPLOYMENT HISTORY Please give accurate, complete full and part time employment information. Start with your present or most recent employer. Rate

3 We may contact the employers listed above unless you indicate those you do not want us to contact. Please do not contact the following employer(s) Reason(s) Please list and describe other activities, or memberships in professional or civic organizations, related to the position for which you are applying. Exclude those which may disclose your race, color, religion or national origin. Please include any special training, skills or certification and expiration date, you feel to be pertinent to the position for which you are applying. Are you a veteran? No Yes Have you ever been convicted of a felony? No Yes, If yes, give details Please provide three (3) professional references: Name: How long have you known this person: Relationship to you: Phone Number(s): Name: How long have you known this person: Relationship to you: Phone Number(s): Name: How long have you known this person: Relationship to you: Phone Number(s): Please tell us why you would like to work for Easter Seals and what contributions and/or qualifications you have which would help us meet our mission - To serve people who have disabilities, their families and the community by providing programs, advocacy, education and support, enhancing the quality of life in Iowa.

4 PLEASE READ AND SIGN THE FOLLOWING PAGE SUBSTANCE ABUSE AND TESTING POLICY NOTICE TO ALL JOB APPLICANTS Easter Seals of Iowa is a drug free workplace. Offers of employment at this facility will be contingent on passing a pre-employment drug screen. Applicants, who fail or refuse to submit to the pre-employment drug screen, will not be considered for employment. In addition, employees may be required to submit to additional drug testing throughout the course of employment in accordance with the Company s Substance Abuse and Testing Policies. All applicants are encouraged to consider this policy before applying for employment at this facility. If you use illegal drugs, please do not apply. I certify that, to the best of my knowledge, the information contained in this application is correct. I understand that falsification of any information in this application is grounds for refusal to hire or, if I have been hired, grounds for termination. I authorize my references, including personal and employment, to provide Easter Seals with all information pertinent to this application, and I release all parties from liability for any damages that may result from the release of any information as part of the employment verification process. I understand that Easter Seals has a policy of employment at will and that, if I am hired, my employment may be terminated either

5 by myself or Easter Seals at any time, with or without notice. I also acknowledge that I may be required to complete a health history form. SignedDate ESSI 6/99, 10/11