WE VALUE DIVERSITY
APPLICATION FOR EMPLOYMENT
Specific position applying for:
Program:
Today's Date:
Applicants: In order to be considered for employment, this application must be completed entirely. Please remember to print clearly, and to read and sign on the last page. If you need help interpreting and/or completing this form, please call Janus Youth Programs at 503-542-4610.
Full NameHome PhoneMessage Phone
Address City State Zip
Why are you interested in this particular job?
What skills and training qualify you for this position?
What portions of your work experience qualify you for this job?
What are three of your greatest professional strengths?
What are three of your greatest weaknesses/growth areas?
EMPLOYMENT HISTORY- This section must be completed entirely (Resume will not substitute).
List below ALL paid or unpaid work experiences beginning with your present or most recent job. (Include also any military work experience.) Describe each job separately, emphasizing your specific tasks and supervisory, technical or other responsibilities. Explain significant breaks in your work experience. If you need more space than provided, additional sheets may be attached.
PRESENT OR PAST POSITION
EmployerFrom(month) (year)
AddressTo(month) (year)
Your TitleSupervisors name and telephoneFull Time Part time
Duties/responsibilities (be specific)Hrs./Week (If varied, indicate average)
Paid Unpaid
Starting yearly salary
Last yearly salary
Reason for leaving
2)
EmployerFrom(month) (year)
AddressTo(month) (year)
Your TitleSupervisors name and telephoneFull Time Part time
Duties/responsibilities (be specific)Hrs./Week (If varied, indicate average)
Paid Unpaid
Starting yearly salary
Last yearly salary
Reason for leaving
3)
EmployerFrom(month) (year)
AddressTo(month) (year)
Your TitleSupervisors name and telephoneFull Time Part time
Duties/responsibilities (be specific)Hrs./Week (If varied, indicate average)
Paid Unpaid
Starting yearly salary
Last yearly salary
Reason for leaving
List all other positions you have held beyond the three most recent ones in the last 10 years. Attach additional sheets if necessary.
EmployerAddress
Your titleYour salary
Dates of EmploymentReason for leaving
EmployerAddress
Your titleYour salary
Dates of EmploymentReason for leaving
EmployerAddress
Your titleYour salary
Dates of EmploymentReason for leaving
EDUCATION
Circle the highest grade completed in school 1 2 3 4 5 6 7 8 9 10 11 12 College 1 2 3 4 Graduate 1 2 3 4
Name of SchoolLocationDiploma/DegreeMajor
High School
College or University
Graduate School
Vocational Training
ADDITIONAL INFORMATION
Professional and Trade Licenses
Have you ever been convicted, plead guilty or no contest, or forfeited bond or bail for any crime other than a traffic violation?
Yes No
If yes, please explain. (Conviction will be considered on an individual basis and may not necessarily preclude employment.)
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PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING THE APPLICATION:
Janus Youth Programs is committed to equal employment opportunity both in principle and practice. Our policy is to recruit, hire, train, promote and make other decisions about employment status without discrimination on the basis or race, gender, marital status, veteran’s status, religion, national origin, age, sexual orientation, gender identity, caretaking responsibility, genetic information, physical or mental disability (if the individual is qualified for this position with or without reasonable accommodation), pregnancy, childbirth, or related medical condition, citizenship, or any other status protected under applicable federal, state or local laws and regulations.
Interviews are given on a competitive basis, using job-related factors. Because of the large number of applications received, not everyone who applies for a vacant position will be interviewed.
I certify that I have answered truthfully and not knowingly withheld any information relative to my application. I understand that any misrepresentation or material omission on this application will result in my being eliminated from further consideration. I further understand that, if accepted for employment, any misrepresentation or material omission, which becomes known to the organization will result in immediate termination of my employment.
I authorize all previous employers and supervisors, including all persons for whom I have worked, to give the organization’s representative any and all information regarding me and my previous employment. I release the organization and all previous employers and supervisors from liability for any damages that may result from furnishing information to Janus Youth Programs, Inc. I also authorize Janus Youth Programs, Inc., to obtain information from official sources concerning my driving record and records of unlawful or criminal activities for the purpose of determining my suitability for employment. As part of this process, once I am offered a position, it may be necessary to submit my fingerprints for a nationwide criminal history record check. I understand that, if selected for employment, I will be required to provide proof of my identity and my legal right to work in the United States prior to actual employment. This employer will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee’s Form I-9 to confirm work authorization. IMPORTANT: If the Government cannot confirm that you are authorized to work, this employer is required to provide you written instructions and an opportunity to contact SSA and/or DHS before taking adverse action against you, including terminating your employment. Employers may not use E-Verify to pre-screen job applicants or to re-verify current employees and may not limit or influence the choice of documents presented for use on the Form I-9. In order to determine whether Form I-9 documentation is valid, this employer uses E-Verify’s photo screening tool to match the photograph appearing on some permanent resident and employment authorization cards with the official U.S. Citizenship and Immigration Services’ (USCIS) photograph. If you believe that your employer has violated its responsibilities under this program or has discriminated against you during the verification process based upon your national origin or citizenship status, please call the Office of Special Counsel at 1-800-255-7688 (TDD: 1-800-237-2515).
In consideration of my employment, I agree to conform to the instructions, rules and policies of the organization to which I am applying. I understand that my employment and compensation can be terminated at any time with or without cause and with or without notice, at the option of either the organization or me subject to the established personnel policies. I understand that no representative of the organization, other than the Executive Director or his/her designee has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.
Signature of ApplicantDate
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