Application For Employment – Macon Citizens Habilities

Macon Citizens Habilities Application for Employment

Macon Citizens Habilities, Inc.

Application for Employment

It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability, or other protected classification.

Name:

Date:

Address:

Phone/Mobile

Email:

Are you at least 21 years old?

Yes

Are you authorized to work in the U.S. on an unrestricted basis?

Yes

What position(s) are you applying for?

How did you learn of this opening?

When can you start?

Have you worked here before?

Yes

If yes, Employment Date:

Have you been told the essential functions of the job or have you been shown a copy of the job description listing the essential functions of the job?

Yes

Can you perform these functions with or without reasonable accomodation?

Yes

Are there any hours, shifts, or days that you cannot or will not work?

Shift preferred:

Hours per pay period:

Full Time

Part Time

Are you willing to work overtime as required?

Yes

Education

High School:

Graduated:

Diploma

GED

Year Graduated:

College/University:

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Degree:

Year Graduated:

Other Trainings/Education:

Work History

1) Most recent/ Current Employer:

Name and title of Supervisor:

Phone Number:

Address of business:

Position when hired:

Start Date:

Starting Salary:

Position on leaving:

Ending Salary:

End Date

Description of Duties:

Reason for leaving

2) Previous Employer:

Name and title of Supervisor:

Phone Number:

Address of business:

Position when hired:

Start Date:

Starting Salary:

Position on leaving:

End Date

Ending Salary:

Description of Duties:

Reason for leaving

Applicant's Certification and Agreement

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize MCH to make an investigation of any of the facts set forth in this application, including references.

By signing, or entering my name online, I authorize MCH to check references. I understand that employment at MCH is "at will" which means that either I or MCH can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of MCH, other than the Executive Director or Board has any authority to alter the foregoing.

Failure to sign, or enter your name online, will be considered an incomplete application and will not be considered.

Applicant Signature:

Date / Time

References

Please list below 2 personal and 2 work-related references (please list supervisors or managers only) which we may contact. Please give complete names and phone numbers for each. Failure to give complete information may render your application invalid. Please sign below to authorize MCH to check your references.

Personal Reference 1: Family Member

Phone Number:

Personal Reference 2: Non- Family Member

Phone Number:

Work Reference 1: Supervisor or Manager only

Business Name and Title:

Phone Number:

Work Reference 2: Supervisor or Manager only

Business Name and Title:

Phone Number:

Information Release Authorization

I authorize all corporations, former employers, personal references, credit agencies, educational institutions to release information about my background including, but not limited to information about my employment, education, and general records history to MCH. This releases the aforesaid parties from any liability and responsibility for collecting the above information.

First Name

Last Name

Date / Time