CAPC Application -

  • Date Format: MM slash DD slash YYYY
  • Employment 1

  • EmployerTelephoneDates of Employment (From mm/yy To mm/yy)Address 
  • Job TitleImmediate Supervisor & TitleRate/Salary (Start - Finish)May We Contact for Reference? 
  • Employment 2

  • EmployerTelephoneDates of Employment (From mm/yy To mm/yy)Address 
  • Job TitleImmediate Supervisor & TitleRate/Salary (Start - Finish)May We Contact for Reference? 
  • Employment 3

  • EmployerTelephoneDates of Employment (From mm/yy To mm/yy)Address 
  • Job TitleImmediate Supervisor & TitleRate/Salary (Start - Finish)May We Contact for Reference? 
  • Employment 4

  • EmployerTelephoneDates of Employment (From mm/yy To mm/yy)Address 
  • Job TitleImmediate Supervisor & TitleRate/Salary (Start - Finish)May We Contact for Reference? 
  • 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.

  • NameTelephoneHow do know this reference? 
    Please Click to the Right of the Line to Add More References
  • 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 further understand that this company is a DRUG-FREE WORKPLACE and if selected for employment, I must submit to a drug test prior to being employed and during employment.

    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 ApplicantDate 
  • 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.

  • This field is for validation purposes and should be left unchanged.