Community Action Job Application - Community Action Program Committee

I'm applying for this position:(Required)

Date of Application(Required)

Name(Required)

First Middle Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

    Have you ever worked in a facility that has had a license denied, revoked, or suspended in any state or jurisdiction; or has been the subject of disciplinary action; or been fined while employed in a child care facility?(Required)

Yes
No

    Have you ever been convicted of a felony or pled "no contest" to a felony charge?(Required)

Yes
No

If yes, please explain:   

Do you own a vehicle?(Required)

Yes
No

If so, check if it can be used in your work?(Required)

Yes
No

    Do you have a vaild Florida Driver's License?(Required)

Yes
No

Do you have a CDL?

Yes
No

What class & endorsements if CDL?   

Educational Background    (Required)

High School
Community College
University
Business or Trade School
GED Certificate

    Do you have a CDA Certificate?(Required)

Yes
No

Do you have your DCF forty-hour (40) childcare certificate? (Transcript is required)(Required)

Yes
No

Employment 1

Employer	Telephone	Dates of Employment (From mm/yy To mm/yy)	Address

Job Title	Immediate Supervisor & Title	Rate/Salary (Start - Finish)	May We Contact for Reference?

Reason for Leaving

Summarize Type of Work & Responsibilities

Employment 2

Employer	Telephone	Dates of Employment (From mm/yy To mm/yy)		Address

Job Title	Immediate Supervisor & Title	Rate/Salary (Start - Finish)	May We Contact for Reference?

Reason for Leaving

Summarize Type of Work & Responsibilities

Employment 3

Employer	Telephone	Dates of Employment (From mm/yy To mm/yy)	Address

Job Title	Immediate Supervisor & Title	Rate/Salary (Start - Finish)	May We Contact for Reference?

Reason for Leaving

Summarize Type of Work & Responsibilities

Employment 4

Employer	Telephone	Dates of Employment (From mm/yy To mm/yy)	Address

Job Title	Immediate Supervisor & Title	Rate/Salary (Start - Finish)	May We Contact for Reference?

Reason for Leaving

Summarize Type of Work & Responsibilities

Skills & Training(Required)

Summarize any special training, skills, licenses, and/or certifications that may qualify you as being able to perform job-related functions in the position(s) for which you are applying. 

What personal qualities do you possess that will help you fulfill the position for which you are applying?   

List any additional information you would like us to consider.   

    References   (Required)

Name	Telephone	How do know this reference?

Please Click to the Right of the Line to Add More References

Are you a current or former Head Start parent?(Required)

Yes
No

    Are you a former Head Start Student?(Required)

Yes
No

How did you hear about this job opening? Please mark all that apply(Required)

Pensacola News Journal
Workforce Escarosa
Community Action Program
CAPC Website
CareerBuilder.com
CAPC Start Employee
CAPC Facebook Page
CAPC ENews
Other

Other

Please Upload Your Resume if Possible

Max. file size: 8 MB.

I Understand(Required)

I understand that if l am employed, any misrepresentation or material omission made by me on this application will be sufficient cause for cancelation of this application or immediate discharge from the employer's service, whenever it is discovered.

I give the employer the right to contact and obtain information from all references, employers, educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the employer and its representatives for seeking, gathering, and using such information and all other persons, corporations, or organizations for furnishing such information.

The employer does not unlawfully discriminate in employment and no question or this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state, or federal law.

I understand that employment with CAPC, Inc. is "AT WILL" and that I am free to resign at any time, with or without cause and the employer reserves the same right to terminate my employment at any time, with or without cause except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. Resignation must be submitted in accordance with the agency's personnel policies and procedures.

I understand it is this company's policy not to refuse to hire a qualified individual with a disability because of that person's need for a reassurance accommodation as required by the ADA.

I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization within three (3) days.

I understand that the condition of my employment is subject to a background screening.

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

Employment applications are the property of the agency.

Name of Applicant	Date

I understand that if I am selected for an interview I will be required to physically sign this form.

AN EQUAL OPPORTUNITY EMPLOYER

The Community Action Program Committee, Inc. does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status in any of its activities or operations. These activities include, but are not limited to, hiring and firing of staff, selection of volunteers and vendors, and provision of services. We are committed to providing an inclusive and welcoming environment for all members of our staff, clients, volunteers, contractors, vendors, and clients.

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CAPC Application -

Employment 1

Employment 2

Employment 3

Employment 4

AN EQUAL OPPORTUNITY EMPLOYER