Employment Application - CAASTLC, Inc. - Services Toward Empowering People,Inc.

Employment Application

CAASTLC, Inc. is an equal opportunity employer and does not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to employment, services, and programs is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the organization.

PERSONAL INFORMATION

Date:

Applicant Name:

Address:

City:

State: Zip:

Phone Number:

Social Security#:

Email:


EMPLOYMENT DESIRED
Position(s) applied for or type of work desired:
Type of employment desired: Full Time Part Time Temporary
Date you will be able to work:
Do you have objection to working overtime if necessary?	Yes	No
Can you travel if required by this position?	Yes	No
Have you ever been previously employed by CAASTLC, Inc. (formerly known as Metroplex, Inc.)?	Yes	No
Are you now employed?	Yes	No
If currently employed, may we inquire of your present employer?	Yes	No
Can you submit proof of legal employment authorization and identity?	Yes	No
If you are under 18, can you furnish a work permit, if it is required?	Yes	No
Have you ever been convicted of a crime?	Yes	No
If Yes, please explain (a conviction will not automatically bar employment):
Do you have the capacity to perform the duties for which you have applied?	Yes	No
If No, please explain:

Driver's license number (if driving is an essential job duty):
Issuing State:
Auto Insurance Carrier:
How were you referred to us?

Do you currently have friends or relatives employed by CAASTLC, Inc. or current members of the Board of Directors?

Yes

EMPLOYMENT EXPERIENCE
Please provide all employment information for your past four employers starting with the most recent.

*Present Employer*
Current Employer:
Position Held:
Address:
City:
State:	Zip:
Phone Number:
Immediate supervisor and title:
Dates employed:	from to
Salary:
Job Duties:
Reason for leaving:

Employer #2
Employer:
Position Held:
Address:
City:
State:	Zip:
Phone Number:
Immediate supervisor and title:
Dates employed:	from to
Salary:
Job Duties:
Reason for leaving:

*Employer #3*
Employer:
Position Held:
Address:
City:
State:	Zip:
Phone Number:
Immediate supervisor and title:
Dates employed:	from to
Salary:
Job Duties:
Reason for leaving:

*Employer #4*
Employer:
Position Held:
Address:
City:
State:	Zip:
Phone Number:
Immediate supervisor and title:
Dates employed:	from to
Salary:
Job Duties:
Reason for leaving:

OTHER SKILLS AND QUALIFICATIONS
Summarize any job-related training, skills, licenses, certificates, and/or other qualifications.

EDUCATIONAL HISTORY
Education: (highest grade completed)
High School Name:
Address:
City:
State:
Years Completed:
Courses of Study:
Diploma/Degrees Earned:

College Name:
Address:
City:
State:
Years Completed:
Courses of Study:
Diploma/Degrees Earned::

Technical Training:
Address:
City:
State:
Years Completed:
Courses of Study:
Diploma/Degrees Earned:

Other:
Address:
City:
State:
Years Completed:
Courses of Study:
Diploma/Degrees Earned:
REFERENCES List three (3) references (do not include relatives or employers).
Name:
Address:
City:
State:
Zip:
Telephone:

Name:
Address:
City:
State:
Zip:
Telephone:

Name:
Address:
City:
State:
Zip:
Telephone:

EMERGENCY RECORD In case of emergency notify:
Name:
Relation:
Address:
City:
State:
Zip:
Telephone:

I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.

If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that persons need for a reasonable accommodation as required by the ADA.

I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three (3) days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.

I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.

After you submit this form you will be taken to a page where you
can upload your resum� to us for review.

CAASTLC, Inc. disclaims any warranties regarding the accuracy
or completeness of any information appearing on this website.