FOR Employmenttransitions Inc

APPLICATION

FOR EMPLOYMENTTransitions Inc.

Transitions Incorporated is an equal opportunity employer and does not discriminate against applicants or employees on the basis of sex, race, color, religion, national origin, ancestry, or age (40 years of age and over).
In addition, Transitions Incorporated does not discriminate against qualified individuals with disabilities.
Transitions Incorporated participates in E-Verify. Please fill out the entire application, do not leave blanks.

How Did You Learn About Us?

AdvertisementFriendWalk-In

Employment AgencyRelativeOther: ______

Name: First Middle Last
Street Address City State Zip
Home Phone Cell Phone Email Address

EMERGENCY NOTIFICATION

In case of emergency notify (Name):
Telephone Number (Home): (Business/Cell):
Address:
Relationship:

Position(s) applied for: ______

Date available to start: ______Are you over 21 years of age?  Yes  No

Have you ever been employed with us before?  Yes  No If yes, when? ______

Have you applied to work with us before?  Yes  No If yes, when? ______

Are you available to work:  Full Time  Part Time  Shift work  On Call

Are you currently on "lay-off" status and subject to recall? ______

May we contact your present employer? ______

Are you willing to work an irregular schedule, overtime, on different shifts and on weekends when

necessary to Transitions Incorporated?  Yes  No If no, please explain.______

______

Have you ever been a) convicted of any violation of the law, b)engaged in sexual abuse in prison, jail, community confinement, or juvenile lockup, c) convicted of engaging or attempting to engage in sexual activity in the community facilitated by force, overt or implied threats of force, or coercion, or if the victim did not consent or was unable to consent or refuse, or d) beencivillyoradministrativelyadjudicatedtohaveengagedin any of these activities?  Yes  No - If yes, explain below in detail with dates and offenses. Failure to disclose will result in termination of employment. Be detailed!!!

Misdemeanor/Traffic:

______

Felony:

______

Other:______

______

Do you have any pending criminal charges/cases?  Yes  No If yes, please explain______

______

Are you currently on probation, parole, or other legal supervision?  Yes  No If yes, please

explain.______

Do you have a valid driver’s license? Yes No

Do you have dependable transportation to and from work?  Yes  No If no, please explain:

______

Can you travel if a job requires it?  Yes  No

EDUCATION

Name & Address of School / Course of Study or Major / Years Completed / Diploma/Degree
High School
College
Graduate
Professional
Other
(Specify)

U.S. MILITARY SERVICE

Branch: / Dates of Service: to
Highest Rank Achieved:
Duties:

OTHER EXPERIENCE OR QUALIFICATIONS

Describe any specialized training, apprenticeship, skills, extra curricular activities or training received: ______

EMPLOYMENT HISTORY (most recent employment first)

EMPLOYER: / DATES EMPLOYED / Duties:
STREET ADDRESS: / From To
CITY, STATE, ZIP
TELEPHONE NUMBER(S)
JOB TITLE: / HOURLY RATE/SALARY
SUPERVISOR: / Start Final
REASON FOR LEAVING:
EMPLOYER: / DATES EMPLOYED / Duties:
STREET ADDRESS: / From To
CITY, STATE, ZIP
TELEPHONE NUMBER(S)
JOB TITLE: / HOURLY RATE/SALARY
SUPERVISOR: / Start Final
REASON FOR LEAVING:
EMPLOYER: / DATES EMPLOYED / Duties:
STREET ADDRESS: / From To
CITY, STATE, ZIP
TELEPHONE NUMBER(S)
JOB TITLE: / HOURLY RATE/SALARY
SUPERVISOR: / Start Final
REASON FOR LEAVING:
EMPLOYER: / DATES EMPLOYED / Duties:
STREET ADDRESS: / From To
CITY, STATE, ZIP
TELEPHONE NUMBER(S)
JOB TITLE: / HOURLY RATE/SALARY
SUPERVISOR: / Start Final
REASON FOR LEAVING:

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 other protected status):

______

ADDITIONAL INFORMATION

REFERENCES (1-Personal/3-Professional)

NAME: ASSOCIATION:

ADDRESS: CITY: STATE: ZIP: PHONE:

______

NAME: ASSOCIATION:

ADDRESS: CITY:STATE: ZIP: PHONE:

______

NAME: ASSOCIATION:

ADDRESS: CITY: STATE: ZIP: PHONE:

______

NAME: ASSOCIATION:

ADDRESS CITY: STATE: ZIP: PHONE:

ESSAY QUESTION

In a half page or less, please write your response to the following question: How does your background and abilities qualify you for the job position for which you are applying?

______

THIS APPLICATION FOR EMPLOYMENT SHALL REMAIN ACTIVE FOR 60 DAYS.

CERTIFICATION AND AUTHORIZATION (Please read thoughtfully)

I certify that all facts contained in the application are true and complete. I authorize Transitions Incorporated to verify the accuracy of the information provided herein.

I authorizemy former employers and educational institutions to provide information concerning me, and I release them from liability for providing any such information to Transitions Incorporated. I further authorize Transitions Incorporated to provide to others information concerning me, and I release Transitions Incorporated from liability for providing any such information.

I understand that falsification, misrepresentation, or omission of requested facts will result in denial of employment or if employed, will result in immediate dismissal. I understand and agree that, if hired, my employment will be for no definite period and may, regardless of the date of payment of wages, be terminated at any time without previous notice and with or without reason, at the will of either myself or Transitions Incorporated. I also understand and agree that no one has authority to promise me job security or continued employment, except the Executive Director of Transitions in a formal written agreement signed by both of us. I also understand and agree that my employment is contingent upon approval by funding sources and contract providers of Transitions Inc.

I understand, also that employment is contingent upon a negative drug screening, and

I agree to submit to a drug test.

______

Signature of Applicant Date