Greater Lawrence Community Action Council, Inc.

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Online Application

First Name:

Middle Name:

Last Name:

Email Address:

Present Address:

City:

State:

Zip Code:

Telephone:

Highest Grade in School Completed:

List any language other than English you read, write or speak:

Business

Name:

Years:

Months:

Graduate:

List type of work which you wish to apply:

Are you employed now?:

When are you available for work?:

Would you work full time?:

Part time?:

Substitute?:

EMPLOYMENT HISTORY

Years: From To

Note: Years should be in the form: From "1987" to "1993"

Employer:

Address:

Phone:

Type of Work:

Years: From To

Employer:

Address:

Phone:

Type of Work:

List any certificates, awards, or community service

Have you ever been arrested for other than a minor traffic violation?:

Do you have any physical condition, which may limit your ability to perform the job for which you have applied? :

Have you ever been dismissed or asked to resign from any position?:

Have you ever been employed by CAPS- Greater Lawrence Community Action Council, Inc. in any capacity?:

For each question answered yes, please provide a statement explaining the circumstances in the box below:

If employed, you will be required to furnish information on age, citizenship clearance through the Department of Justice, freedom from communicable disease, and right to work in this country if applicable.

I certify that all statements made hereon are true and correct to the best of my knowledge. I understand that any false statements made on this application may be cause for non-employment or for dismissal if employed.

I hereby authorize any investigation to obtain information required by this application.

TYPE NAME:

Date:

AN EQUAL OPPORTUNITY EMPLOYER

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CAPS- Greater Lawrence Community Action Council, Inc.

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EMPLOYMENT HISTORY

Online Application