Employment Application Employment Application 2021 1Personal Information2Education3Previous Employment 4References5Background Information6Skills & Abilities7Submit Name * Required First Last Social Security # * Required Email * 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? Yes No Permanent 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? Yes No Permanent Phone * RequiredPosition Applying For: * Required Type of Employment Desired: * Required Full Time Part Time Temporary / Seasonal On Call Date Available * Required MM slash DD slash YYYY Desired Salary (Hourly/Yearly) * Required What 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). Monday Tuesday Wednesday Thursday Friday Saturday Sunday Have 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. Yes No If so, when? MM slash DD slash YYYY Are you 18 years or older? * Required Yes No Do you have a record of founded child/dependent adult abuse in this state or any other state? * Required Yes No Have 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. Yes No Please 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? Yes No High School Location Course Studied Years Completed GPA Degree Recieved Did you graduate college/university? Yes No College/University Location Major/Course Studied GPA Years Completed Degree(s) Received Major (If Degree Received) Other Eduation? Yes No Name Location Major/Course Studied Years Completed GPA Degree(s) Received Major (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 Used Including maiden name. How long have you lived at your current address? * Required Please 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? Yes No If yes, what other language(s)? Do you have a valid Drivers License? Yes No If yes, what state? Drivers License # Expiration Date Computer Skills / KnowledgeOther Skills, Licenses or CertificationsList any additional information appropriate for consideration: SubmitResume or Cover Letter (optional) Drop files here or Select files Accepted file types: jpg, png, pdf, , Max. file size: 300 MB, Max. files: 3. 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.Signature Reset signature Signature locked. Reset to sign again Date 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.
