• APPLICATION FOR EMPLOYMENT

    • Applicant Information 
    • Format: (000) 000-0000.
    • Are you at least 18 years of age?*
    • Are you a U.S. citizen/permanent resident/foreign national with authorization to work in the U.S.?*
    • Have you ever been convicted of/entered a plea of no contest/had a judgement withheld to a felony? (Note: Medicaid guidelines require a background check).*
    • Employment Desired 
    • Do you want full-time or part-time employment?*
    • Please indicate the days and times you are available to work:*
      Rows
    • Education/Certification 
    • Are you currently certified in CPR AND do you have a copy of your card?*
    • Are you currently certified in First Aid AND do you have a copy of your card?*
    • Employment History 

    • Employer #1

    • Format: (000) 000-0000.
    • May we contact this employer?

    • Employer #2

    • Format: (000) 000-0000.
    • May we contact this employer?

    • Employer #3

    • Format: (000) 000-0000.
    • May we contact this employer?
    • References 

    • Reference #1

    • Format: (000) 000-0000.

    • Reference #2

    • Format: (000) 000-0000.

    • Reference #3

    • Format: (000) 000-0000.
    • Declaration & Signature 

    • Community Services, Inc. (CSI) is an equal opportunity employer. I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I acknowledge that I meet all requied qualifications for this position and am able to perform the job responsibilities outlined in the job posting. 

    • Date
       / /
      2 digit month, 2 digit day, 4 digit year
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