Employment Application


Employment is contingent upon the applicant's providing the necessary proof of citizenship or legal authorization to work in the United States. Proof of status will be required upon employment. CompAfriCare is an equal-opportunity employer. We do not discriminate in hiring because of age, race, creed, color, national origin, sex, or handicap.

Name :
First :
Middle :
Last :
 
For checking prior records, provide other names under which you have worked :
Social Security :
 

PRESENT ADDRESS:
Street :
City :
State :
ZIP :
Home Phone :
Work or message phone :
Fax :
E-Mail :
 

Resume :
Resume (Upload or write) :
cover letter
 

AVAILABILITY
Availability :
When will you be available to start work? :
Specify part time hours :
Will you work overtime if needed? :
Position desired :
Salary desired :
How were you referred to us? :
 

Special Skills or Qualifications
If under 18 years of age, can you provide proof of your eligibility to work? :
Do you have relatives currently employed by CompAfriCare? :
If yes, please specify
 
List names of educational institutions you attended relevant to the position you are seeking :
Educational Institution/Location Course of Study Certificate/Degree
1.
2.
3.
4.
5.
 
List professional organizations, memberships, volunteer activities which may be job relevant. (Exclude those which indicate race, color, creed, religion, age, national origin, or sex.)
List relevant skills and/or business machines you can operate which may be job relevant.
 
Computer programs you are proficient in using. Check all that apply. List specific programs :
Word Processing
Presentation
Spreadsheet
Database
Desktop Publishing
Windows Ver.
Macintosh Ver.
UNIX
 
Administrative skills you are proficient in using (whether applying for program or support position) Check all that apply. :
Telephone
Daily Mail
Filing
Collating
Meeting Arrangements
Travel Arrangements
Photocopying
Faxing
E-Mailing
Proofreading
Other
Beginning with your present or most recent position, list the last three jobs you have held, including a summary of major duties, software activities, etc. Indicate military experience.
Employer:
Type of Business:
Street:
City:
State:
ZIP :
Phone :
Dates Employed:
From :
To :
Titles:
Start :
Last :
Salary :
Start:
Final :
 
Supervisor :
Reason for Leaving :
Brief description of duties :
 
 
Employer:
Type of Business:
Street:
City:
State:
ZIP :
Phone :
Dates Employed:
From :
To :
Titles:
Start :
Last :
Salary :
Start:
Final :
 
Supervisor :
Reason for Leaving :
Brief description of duties :
 
 
Employer:
Type of Business:
Street:
City:
State:
ZIP :
Phone :
Dates Employed:
From :
To :
Titles:
Start :
Last :
Salary :
Start:
Final :
 
Supervisor :
Reason for Leaving :
Brief description of duties :
 
Summarize prior relevant experience and fill in periods of unemployment or periods not accounted for in previous sections.

I hereby affirm that the information provided on this application, and on any resume I have furnished, is true and complete to the best of my knowledge. Any false information or significant omissions may disqualify me from further consideration for employment and, should I be employed by CompAfriCare, may justify termination of my employment if discovered at a later date.

I hereby authorize CompAfriCare to contact the persons, schools, employers and other organizations named in this application or any accompanying resume approved below to confirm the information which I have provided to obtain any additional information needed to make an employment decision about me.
 
CompAfriCare is authorized to contact:
All employers named on this application and any accompanying resume.
All employers named on this application and any accompanying resume, except my current employer

If authorization to contact current employer is withheld by applicant and a contingent offer of employment is made to applicant by CompAfriCare to secure approval for current references, CompAfriCare may rescind offer of employment upon receipt of unsatisfactory references.
 

Applicant Information Sheet
CompAfriCare is an equal opportunity/affirmative action employer. We invite all applicants to provide the information below in order to assist us in satisfying our obligation under federal, state and local fair employment practice laws. The information you provide will be maintained separately from records available to those responsible for personnel decisions.
Please indicate your sex :
Male Female
Please indicate your race/ethnic category :
White
Black/African American
American Indian or Alaskan Native
Asian or Pacific Islander
Unspecified, Some other race
Are you from Hispanic or Latino Origin?
Yes No
 


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