CIS of Benton-Franklin Site Coordinator
Send completed packets to at the CIS of Washington State Office
Priority closing date is noon on January 25, 2016.
Position will remain open until filled.
For consideration, application packets must contain:
· A cover letter describing how you are qualified for this position
· This completed application
· Your resume
Application
Date: ____________________
Name _______________________________________________________________
(last) (first) (middle)
Address __________________________________________________________________
_________________________________________________________________________
Email address: ___________________________
Home/Cell Telephone: _______________ Business/Message Phone: ________________
EDUCATION AND TRAINING
Degree/College or University _________________________________________________
Degree/College or University _________________________________________________
Other Education: __________________________________________________________
Below List Other Relevant Trainings/Courses
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
EMPLOYMENT HISTORY (Current or most recent employer first, add additional pages if necessary)
Dates of Employment
From ______ To ______ Employer ______________________ Phone________________
(mo/yr) (mo/yr)
Employer’s Address ____________________________________
End Salary _______________ ____________________________________
Your Title _____________ ___Supervisor’s Name _________________________________
Specific Duties _____________________________________________________________
_________________________________________________________________________
Reason For Leaving _________________________________________________________
Name Known To Employer If Different Than Present Name __________________________
…………………………………………………………………………………………………………….
Dates of Employment
From ______ To ______ Employer ______________________ Phone________________
(mo/yr) (mo/yr)
Employer’s Address ____________________________________
End Salary _______________ ____________________________________
Your Title _____________ ___Supervisor’s Name _________________________________
Specific Duties ______________________________________________________________
__________________________________________________________________________
Reason For Leaving _________________________________________________________
Name Known To Employer If Different Than Present Name __________________________
…………………………………………………………………………………………………………….
Dates of Employment
From ______ To ______ Employer ______________________ Phone________________
(mo/yr) (mo/yr)
Employer’s Address ____________________________________
End Salary _______________ ____________________________________
Your Title _____________ ___Supervisor’s Name _________________________________
Specific Duties ________________________________________________________________________
__________________________________________________________________________
Reason For Leaving _________________________________________________________
Name Known To Employer If Different Than Present Name __________________________
References
List below 3 persons other than relatives who have known you for more than 3 years.
Name Occupation Phone
___________________________ __________________ _______________
___________________________ __________________ _______________
___________________________ __________________ _______________
EQUAL OPPORTUNITY EMPLOYER: Communities in Schools is an Equal Opportunity Employer and does not discriminate against applicants or employees based upon race, religion, color, sex, national origin, sexual orientation, age, marital status, disability or any other basis protected by law.
PLEASE READ CAREFULLY AND SIGN
Have you been convicted or pled guilty to any offense such as kidnapping, assault, murder, rape, indecent liberties or exposure, incest, promoting prostitution, sexual exploitation of minors, child abuse or neglect, custodial interference, child molestation, sexual misconduct with a minor, promoting pornography, selling or distributing erotic material to minors, robbery, extortion, manslaughter, arson, burglary, criminal mistreatment, violation of a child abuse restraining order, or child abandonment? If yes, explain the crime for which you were convicted and the place and date of conviction.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
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Have you: (1) been found in any dependency action to have sexually assaulted or exploited any minor or to have physically abused any minor; (2) been found by any court in a domestic relations proceeding to have sexually abused or exploited any minor or to have physically abused any minor; (3) been found in any disciplinary board final decision to have sexually or physically abused or exploited any minor or developmentally disabled person or to have abused or financially exploited any vulnerable adult; or (4) been found by a court in a protection proceeding to have abused or financially exploited a vulnerable adult? If yes, explain the finding and the tribunal reaching that finding, and the date and place of the finding.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
I hereby authorize Communities In Schools of Washington to inquire as to my record with former employers, references, or public agencies with no liability arising there from. I hereby guarantee the correctness of the above statements. Information in violation of State and Federal fair employment practice laws will not be sought or used by Communities In Schools of Washington. The making of any false statement herein will be sufficient cause for dismissal. Further, I agree to release Communities In Schools of Washington from any liability from any and all claims arising from inquiry as to the record of conviction with former employers, references, or public agencies.
___________________________________
(Signature of applicant)
____________________________________
(Date)
A CONVICTION RECORD DOES NOT
NECESSARILY DISQUALIFY YOU FOR EMPLOYMENT