We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.

Position Applying For(Required)

Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

How did you learn about us(Required)

Best time to contact you at home is(Required)

:

If you are under 18 years of age, can you provide required proof of your eligibility to work?(Required)

Yes

No

Have you ever filed an application with us before? If yes, give date(Required)

Yes

No

Date

Have you ever been employed with us before? If yes, give date(Required)

Yes

No

Date

Do any of your friends or relatives, work here? If yes, state name and relationship.(Required)

Yes

No

Name and Relationship

Are you currently employed?(Required)

Yes

No

May we contact your present employer?

Yes

No

Have you ever been convicted of a crime, or dismissed from employment due to abuse of clients or residents?(Required)

Yes

No

Date available for work(Required)

What's your desired salary range?(Required)

Are you available to work(Required)

Full Time

Part Time

Temporary

Are you currently on "lay off" status and subject to recall?(Required)

Yes

No

Can you travel if a job requires it?(Required)

Yes

No

If you have ever lived out of state, please list your last 3 addresses and dates lived:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Comments and any explanations can be listed below. Please explain which question you are referring to.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

Education

Name and Address of School(Required)

Course of Study(Required)

Years Completed(Required)

Diploma/Degree(Required)

Name and Address of School

Course of Study

Years Completed

Diploma/Degree

Name and Address of School

Course of Study

Years Completed

Diploma/Degree

Name and Address of School

Course of Study

Years Completed

Diploma/Degree

Work Experience

Start with your present or last job. Include any job-related military service assignment, and volunteer activities.You may exclude organizations which indicate race,color, religion, gender, national origin, disabilities, or other protected status.

Employer 1

Employer

Work Performed

Date Employed

Job Title

Hourly Rate/Salary

Address

Phone

Supervisor

Reason for Leaving

Employer 2

Employer

Work Performed

Date Employed

Job Title

Hourly Rate/Salary

Address

Phone

Supervisor

Reason for Leaving

Employer 3

Employer

Work Performed

Date Employed

Hourly Rate/Salary

Address

Phone

Supervisor

Reason for Leaving

Employer 4

Employer

Work Performed

Date Employed

Job Title

Hourly Rate/Salary

Address

Phone

Supervisor

Reason for Leaving

Comments: Include explanation of any gaps in employment.

Describe any specialized training, apprenticeship, skills, extra-curricular activities, and licensing.

Describe any job-related training received in the United States military.

List professional, trade, business, or civic activities, and offices held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or protected status:

ADDITIONAL INFORMATION Other qualifications: Summarize special job-related skills and qualifications acquired from employment or other experience. Also include license, certificates, etc.

SPECIALIZED SKILLS (Skills/Equipment Operated)

Computer

Word Processing

Spreadsheet

PowerPoint

General Construction

Maintenance

Other (list)

State any additional information you feel may be helpful to us in considering your application:

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED OF THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING. Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given.

Yes

No

PERSONAL/PROFESSIONAL REFERENCES Do not include family members

Name 1(Required)

Phone(Required)

Occupation(Required)

Best time to call(Required)

:

Name 2(Required)

Phone(Required)

Occupation(Required)

Best time to call(Required)

:

Name 3(Required)

Phone(Required)

Occupation(Required)

Best time to call(Required)

:

APPLICANT’S STATEMENT

I certify that answers given herein are true and complete. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall remain active until the position for which the applicant is applying is filled. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

APPLICANT CONSENT

FCCAA is an equal opportunity provider and employer. Providing quality service to the community. A member of Community Action Partnership and the United Way of South Fayette

Signature(Required)

Date(Required)

Application for Employment

Job Application

Education

Work Experience

Employer 1

Employer 2

Employer 3

Employer 4

EEO DATA COLLECTION FORM

APPLICANT’S STATEMENT

APPLICANT CONSENT

Follow Us