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COMMUNITY ACTION OF SOUTH EASTERN WEST VIRGINIA

 APPLICATION FOR EMPLOYMENT

APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS 
 

       PLEASE COMPLETE PAGES 1-4                                                                                                                                               DATE:  

      Name  

                                          First                                                   Last                                               Middle                                             Maiden

     

      Present Address  

                                                     Number                                      Street                                            City                                          State                               Zip

     

      Telephone                                                                         Email

      

      If under 18, please list age 

      

       Position applied for (1)

       (Be specfic)           (2) 

       

       How many hours can you work weekly?                                   Can you work nights?

       Employment desired:                               FULL-TIME ONLY             PART-TIME ONLY               FULL OR PART-TIME  

      

      When are you available for work?  

      TYPE OF SCHOOL                        NAME OF SCHOOL                              LOCATION                            NUMBER OF YEARS                       MAJOR AND DEGREE

                                                                                                                   (Complete Mailing Address) 

      High School                                                    

     

     College                                                              

   

     Bus. Or Trade School                                    

 

     Professional School                                       

HAVE YOU EVER BEEN CONVICTED OF A CRIME?                                    YES                                    NO       

 If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.

 I understand that after Community Action of South Eastern West Virginia receives my Criminal Investigation Background check and if there are findings it can be grounds for immediate dismissal.                         

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APPLICATION FOR EMPLOYMENT

Work Experience

     Please list your work experience for the past five years beginning with the most recent job held.   

      If you were self-employed, give firm name. Attach additional sheets if necessary.                                           

Name of Employer   

Address   

City,State, Zip  

Phone Number   

Name of Last Supervisor   

Employment   

Dates   

Pay or     

Salary   


  From    

  To        


  Start  

  Final  


  Your Last Job 

   

  Reason for leaving (be specific)   


  List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

  

Name of Employer   

Address   

City,State, Zip  

Phone Number   

Name of Last Supervisor   

Employment   

Dates   

Pay or     

Salary   


  From    

  To        

  Start  

  Final  

  Your Last Job  

   

 

  Reason for leaving (be specific)   

  List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

  

Name of Employer   

Address   

City,State, Zip  

Phone Number   

Name of Last Supervisor   

Employment   

Dates   

Pay or     

Salary   


  From    

  To        

  Start  

  Final  

  Your Last Job  

   

  Reason for leaving (be specific)   

  List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

  

May we contact your employer(s)?                YES                  NO               

Did you complete this application yourself?                YES                  NO               

If not, who did?   

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APPLICATION FOR EMPLOYMENT

For Bus Drivers and Meal Carriers Only

Do you have a drivers license?                Yes                          No               

Operator               Commercial(CDL)                       Chauffeur

What is you means of transportation to work?

 Have you had any accidents during the past three years?                    How many?

Have you had any moving violations during the past three years?         How many?

Please list two references other than relatives and previous employers.

Name

Position

Company

Address

Telephone

Email Address

Name

Position

Company

Address

Telephone

Email Address

An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

 

PLEASE READ CAREFULLY

APPLICATION FORM WAIVER

 

In exchange for the consideration of my job application by CASEWV (here in after called "the Company"), I agree
that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either
in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel
manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other CASEWV
practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an
employee of CASEWV or otherwise to change in any respect the employment-at-will relationship between it and the
undersigned and that relationship cannot be altered except by a written instrument signed by the Executive Director
of the CASEWV. Both the undersigned and CASEWV may end the employment relationship at any time, without
specified notice or reason. If employed, I understand that the CASEWV may unilaterally change or revise their
benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or
omission of facts called for is cause for dismissal at anytime without any previous notice. I hereby give the CASEWV
permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby
release CASEWV from any liability as a result of such contract.

I also understand that (I) CASEWV has a drug and alcohol policy with a reputable medical review agency that provides
for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is
a condition of my employment; and (3) continued employment is based on the successful passing of testing under
such policy. [further understand that continued employment may be based on the successful passing of job-related
physical examinations.

I understand that, in connection with the routine processing of your employment application that CASEWV may
request from a consumer reporting agency an investigative consumer report including information as to my credit
records, character, general reputation, personal characteristics, and mode of living. Upon written request from me,
the CASEWV, will provide me with additional information concerning the nature and scope of any such report
requested by it, as required by the Fair Credit Reporting Act.

I further understand that my employment with CASEWV shall be probationary for a period of ninety (90) days, and
further that at any time during the probationary period or thereafter, my employment relation with the Company
is terminable at will for any reason by wither party.

 

 

Signature of applicant:                                  Date: 

 

CASEWV is an equal employment opportunity employer. We adhere to a policy of making employment decisions
without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We
assure you that your opportunity for employment with this CASEWV depends solely on your qualifications.

Thank you for completing this application form and for your interest in our business.