Employment Application

Name:

First Name

Last Name

Date:

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone:

(###)

###

####

Email Address:

Available Start Date:

YYYY

Desired Salary:

Position Applying for:

Are you legally authorized to work in the U.S.?

Have you ever worked for JCEO?

If yes, when?

Are any of your relatives employed with us?

If yes, name and relationship?

Have you ever been convicted of a felony?

If yes, explain:

EDUCATION

High School:

Address:

Street, City, State, and Zip Code

Did you graduate?

Diploma:

College/Vocational:

Address:

Street, City, State, and Zip Code

Did you graduate?

Degree:

Other Education:

Address:

Street, City, State, and Zip Code

Did you graduate?

Degree:

SKILLS

Additional Skills:

List any additional skills, certifications, licenses, technical training, professional achievements or knowledge that would support your qualifications for employment.

REFERENCES

References

Please list three professional references. Please include name, relationship, company, phone number, and address.

PREVIOUS EMPLOYMENT

Company

Address:

Street, City, State, and Zip Code

Phone:

(###)

###

####

From:

YYYY

To:

YYYY

Job Title and Responsibilities:

Reason for Leaving:

Supervisor:

May we contact your previous supervisor for a reference?

Company:

Address:

Street, City, State, and Zip Code

Phone:

(###)

###

####

From:

YYYY

To:

YYYY

Job Title and Responsibilities:

Reason for Leaving:

Supervisor:

May we contact your previous supervisor for a reference?

Company:

Address:

Street, City, State, and Zip Code

Phone

(###)

###

####

From:

YYYY

To:

YYYY

Job Title and Responsibilities:

Reason for Leaving:

Supervisor:

May we contact your previous supervisor for a reference?

Please use this area for any additional information:

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

Employment Application

If you prefer to mail your application please send to:

If you prefer to email your application please send to:

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