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Online Application For Employment

Personal -- Education -- Employment -- Skills -- Background -- Affirmative

Position Applied For: *
How did you learn about this position? AdvertisementRelativeFriendWalk-inAgencyOther
If other please specify:
PERSONAL
First Name:	*
Middle Name:
Last Name:	*
Address:	*
City:	*
County:	*
State:	*
Zip Code:	*
Email:	*
Primary Telephone:	*
Length of time at current residence:
Social Security Number: - -
List previous address(es) within the past five (5) years:

Number Street:
City:
County:
State:
Zip:
Dates of Residence:

Number Street:
City:
County:
State:
Zip:
Dates of Residence:

Number Street:
City:
County:
State:
Zip:
Dates of Residence:

Are you a citizen of United States? *
Are you legally eligible for employment in the United States? *
Have you even been convicted of a felony or misdemeanor? *
If yes, please explain:
Are you currently employed? *
Why are you changing jobs?
Do you have a dependable transportation? *
Do you have a valid driver's license? *
When would you be available to begin work? *
Are you available to work: *
Earnings expected: $ Per (Hour/Year)

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EDUCATION
High School
Name:
Location:
Course of Study:
No. of Years Completed:
Did you Graduate?
Degree or Diploma:
College/University
Name:
Location:
Course of Study:
No. of Years Completed:
Did you Graduate?
Degree or Diploma:
Graduate/Professional
Name:
Location:
Course of Study:
No. of Years Completed:
Did you Graduate?
Degree or Diploma:
Other
Name:
Location:
Course of Study:
No. of Years Completed:
Did you Graduate?
Degree or Diploma:
MEMBERSHIPS IN PROFESSIONAL OR CIVIC ORGANIZATIONS (You may exclude those, which may disclose your race, color, religion, disabilities, sexual orientation, age or national origin)

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EMPLOYMENT EXPERIENCE
(Please begin with your present or most recent employer. Include internship / apprenticeship experience, volunteer work and military service, if any.)
Employer 1
Employer:
Supervisor:
Address:
City:
State:
Zip Code:
Telephone:
Dates Employed:	From To
Job Title:
Hourly Rate / Annual Salary:	Start To
Duties Performed:
Reason for Leaving:

Employer 2
Employer:
Supervisor:
Address:
City:
State:
Zip Code:
Telephone:
Dates Employed:	From To
Job Title:
Hourly Rate / Annual Salary:	Start To
Duties Performed:
Reason for Leaving:

Employer 3
Employer:
Supervisor:
Address:
City:
State:
Zip Code:
Telephone:
Dates Employed:	From To
Job Title:
Hourly Rate / Annual Salary:	Start To
Duties Performed:
Reason for Leaving:

Employer 4
Employer:
Supervisor:
Address:
City:
State:
Zip Code:
Telephone:
Dates Employed:	From To
Job Title:
Hourly Rate / Annual Salary:	Start To
Duties Performed:
Reason for Leaving:

Upload Your Cover Letter:
Upload Your Resume:

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Criminal background checks are required of all final applicants
APPLICANT'S STATEMENT
I hereby declare the information provided by me in this Application for Employment is true, correct and complete to the best of my knowledge. I authorize investigation of all statements and information contained in this Application for Employment as may be necessary in arriving at the employment decision. I understand that this Application is not intended to be a contract for employment. I understand that if employed, any false or misleading information given in my Application or interview(s) are grounds for, and may result in, discharge. I understand also, that if employed, I am required to abide by all present and subsequency issued policies and procedures of the agency.
I AgreeI Disagree
APPLICANTS WILL RECEIVE CONSIDERATION WITHOUT REGARD TO RACE, COLOR, RELIGION, SECUAL, ORIENTATION, NATIONAL ORIGIN, AGE MARITAL OR VETERAN STATUS. MEDICAL CONDITION OR DISABILITY
The National Youth Advocate Program (NYAP) follows the rules and regulations governing fair employment practices. NYAP recognizes and respects an applicant's right to privacy. The results of inquiries made in connection with employment will be treated in confidence by the program. Employees of the National Youth Advocate Program, Inc. are employees-at-will and can be terminated from employment at any time without cause.

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