Employment Application Employment Application 2021 1 Personal Information2 Education3 Previous Employment 4 References5 Background Information6 Skills & Abilities7 Submit Name * Required First Last Social Security # * RequiredEmail * Required Present Address * Required Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Is your present address the same as your permanent address?YesNoPermanent Address * Required Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Present Phone * RequiredAlternate PhoneIs your present phone number the same as your permanent number?YesNoPermanent Phone * RequiredPosition Applying For: * RequiredType of Employment Desired: * Required Full Time Part Time Temporary / Seasonal On Call Date Available - must be mm/dd/yyyy format * Required Date Format: MM slash DD slash YYYY Desired Salary (Hourly/Yearly) * RequiredWhat hours would you be willing/able to work? Please indicate any potential scheduling conflicts (exclude conflicts which would indicate race, religion, age, or other protected status). MondayTuesdayWednesdayThursdayFridaySaturdaySundayHave You Applied with the Crittenton Center or a Center Affiliate before? * RequiredThis includes Stella Sanford Child Development Center, Family Development Center, or Center for Shelter & Youth Development.YesNoIf so, when? - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY Are you 18 years or older? * RequiredYesNoDo you have a record of founded child/dependent adult abuse in this state or any other state? * RequiredYesNoHave you ever been convicted, plead guilty, or received a deferred sentence for a crime (misdemeanor or felony) in this state or any other state? * RequiredThis includes and is not limited to OWI, DWI, etc.YesNoPlease explain:A conviction may bear on the hiring decision, but is not automatic grounds for rejection of your application. Circumstances, as they relate to the job, will be considered.Please List Any Work Related Organizations and Activities.Exclude those, which would reveal race, religion, gender, origin, age, disability, or other protected status. EducationDid you graduate high school?YesNoHigh SchoolLocationCourse StudiedYears CompletedGPADegree RecievedDid you graduate college/university?YesNoCollege/UniversityLocationMajor/Course StudiedGPAYears CompletedDegree(s) ReceivedMajor (If Degree Received)Other Eduation?YesNoNameLocationMajor/Course StudiedYears CompletedGPADegree(s) ReceivedMajor (If Degree Received) Previous EmploymentBegin with most recent position. You may add up to three employers.Previous Employers Company Job Title Actions Edit Delete There are no Employers. Add Employer Maximum number of employers reached. ReferencesReferences Name Occupation Actions Edit Delete There are no References. Add Reference Maximum number of references reached. Background InformationName * Required First Middle Last Other Names UsedIncluding maiden name. How long have you lived at your current address? * RequiredPlease list addresses lived over the past five years. Address Years at This Residence Actions Edit Delete There are no Residences. Add Residence Maximum number of residences reached. Specific SkillsAre you bilingual or multilingual?YesNoIf yes, what other language(s)?Do you have a valid Drivers License?YesNoIf yes, what state?Drivers License #Expiration DateComputer Skills / KnowledgeOther Skills, Licenses or CertificationsList any additional information appropriate for consideration: SubmitResume or Cover Letter (optional) Drop files here or Accepted file types: jpg, png, pdf, . I authorization investigation of all statements contained in this application. I understand that misrepresentation or omission of facts may be cause for dismissal. Further, I understand and agree that if employed, my employment is for now contractual period and may be terminated in compliance with Iowa Employment at will and the established personnel policies of the Agency. I also understand that continued employment is contingent upon a satisfactory completion of background checks, i.e. Department of Criminal Investigation, Department of Motor Vehicles, Child Abuse Registry, etc. (IA Code 237.8) This Agency does not discriminate on the basis of race, religion, gender, national origin age, marital status, physical ability, or political belief. I certify that I have read and understand the above information and the information I have provided is true, correct, and complete.Consent * Required I AgreeI authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts may be cause for dismissal. Further, I understand and agree that if employed, my employment is for no contractual period and may be terminated in compliance with Iowa Employment at will and the established personnel policies of this Agency. I also understand that continued employment is contingent upon a satisfactory completion of background checks i.e., Department of Criminal Investigation, Department of Motor Vehicles, Child Abuse Registry, etc. (IA Code 237.8) This Agency does not discriminate on the basis of race, religion, gender, national origin, age, marital status, physical ability, or political belief. I certify that I have read and understand the above information and the information I have provided is true, correct, and complete.SignatureDate - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY This application will be maintained in an active file for a period of three (3) months from date of application.
