Employment Application

Name: *
Name:
Date: *
Date:
Phone: *
Phone:
Available Start Date: *
Available Start Date:
EDUCATION
From: *
From:
To: *
To:
From
From
To:
To:
From:
From:
To:
To:
SKILLS
List any additional skills, certifications, licenses, technical training, professional achievements or knowledge that would support your qualifications for employment.
REFERENCES
Please list three professional references. Please include name, relationship, company, phone number, and address.
PREVIOUS EMPLOYMENT
Phone: *
Phone:
From: *
From:
To: *
To:
Phone:
Phone:
From:
From:
To:
To:
Phone
Phone
From:
From:
To:
To:

AUTHORIZATION

“By submitting this application, I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information that they may have, personal or otherwise, and release the company from all liability from any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.”

It is the policy of JCEO to provide equal opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law.

If you prefer to mail your application please send to:

Joint Council for Economic Opportunity of Clinton and Franklin Counties, Inc.
Attn: Human Resources
54 Margaret Street
Plattsburgh, NY 12901

Phone: (518) 561-6310
Fax: (518) 562-2947

If you prefer to email your application please send to:

hr@jceo.org