Employment Application

Please fill out our employment application below.

Personal Information
Name*
First Middle Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Alternate Phone
Email*
List any names used if different on this application
Position Applying For?
I am Seeking*
- Full Time
- Part Time
Date available to start work:*
Desired Salary
Are you at least 18 years of Age?*
- Yes
- No
Are you legally authorized to work in the US?*
- Yes
- No
Are you a Veteran?*
- Yes
- No
Are you a present member of the National Guard or Reserves?*
- Yes
- No
Do you have a valid driver's license?*
- Yes
- No
Have you ever been convicted of a felony?*
- Yes
- No
If “Yes” please explain in concise detail below, giving dates and nature of the offense.
NOTE: A “Yes” answer to the above question does not necessarily disqualify an applicant for employment.
Are you employed at the present time?*
- Yes
- No
If employed are we able to contact your present employer?
- Yes
- No
Have you ever applied or worked with our agency in the past?*
- Yes
- No
Do you have a valid WI driver’s license in good standing?*
- Yes
- No
What is your driver’s license number?
When does your driver’s license expire?
Can you provide proof of vehicle insurance?*
- Yes
- No
What shifts are you willing to work?*
- Any
- Day
- Night
- Overnight
Are you willing to work on Holidays?*
- Yes
- No
Are you willing to work on Weekends?*
- Yes
- No
Are you available for overtime hours if required?*
- Yes
- No
What days are you unable to work?
Are you able to meet the attendance requirements of the position?*
- Yes
- No
Have you been referred to Community Alternatives?*
- Yes
- No
If yes, who referred you?
EMPLOYMENT HISTORY
List most recent employment first. Include summer or temporary jobs. Be sure all your experience or employers related to this job are listed here, in the summary following this section or on an extra sheet of paper, if necessary. No more than 10 years of employment history is recommended.
Employer / Company Name*
Address*
Street Address Address Line 2 City State ZIP Code
Supervisor Name:*
Phone*
Job Title*
Dates of Employment*
Description of Primary Responsibilities:*
Duties/Skills
Rate of Pay
Reason for Leaving
Employer / Company 2 Name*
Address*
Street Address Address Line 2 City State ZIP Code
Supervisor Name:*
Phone*
Job Title*
Dates of Employment*
Description of Primary Responsibilities:*
Duties/Skills
Rate of Pay
Reason for Leaving
Employer / Company 3 Name
Address
Street Address Address Line 2 City State ZIP Code
Supervisor Name:
Phone
Job Title
Dates of Employment
Description of Primary Responsibilities:
Duties/Skills
Rate of Pay
Reason for Leaving
Which of the jobs listed in your employment history did you like best?
Which of the jobs listed in your employment history did you like the least?
Education
High School Name*
High School Address*
Year Completed*
Field of Study or Degree*
Graduated*
- Yes
- No
College/University Name
College/University Address
Field of Study or Degree
Graduated
- Yes
- No
Business/Technical
Business/Technical Address
Field of Study or Degree
Graduated
- Yes
- No
Any Additional Education
Please specify Name & Address, Years Completed, Field of Study or Degree Obtained
References
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone
Business
Years Known
Relationship
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone
Business
Years Known
Relationship
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone
Business
Years Known
Relationship
Skills & Qualifications
Please list any special Training/Skills/Qualifications - List all job related training or skills you possesses such as personal abilities, honors, professional licenses, certifications, First Aid, CPR, Fire Safety, Medication Administration , Resident Rights or registrations that should be considered :
Do you speak or write a language other than English (if required for this job)?*
- Yes
- No
If yes, which other languages to your speak?
Do you have any sign language experience (if required for this job)?
- Yes
- No
PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY
➢ Non-discrimination policy: Community Alternatives does not discriminate in hiring or employment on the basis of race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation and any other protected categories. No question on this application is intended to secure information to be used for such discrimination.

➢ I hereby certify that the information contained in this application form is true and correct to the best of my knowledge and agree to have any of the statements checked by Community Alternatives unless I have indicated to the contrary. I understand that any misrepresentation, falsification, or material omission of information on this application may result in my failure to receive an offer, or if I am hired, in my dismissal from employment.

➢ In consideration of my employment, I agree to conform to the rules and standards of Community Alternatives, as amended from time to time at Community Alternatives’ sole discretion. I understand that in accepting this application, Community Alternatives is in no way obligated to provide me with employment and that I am not obligated to accept employment if offered. Furthermore, if employed, I understand that I am employed at will and that my employment and compensation can be terminated with or without cause, and with or without notice at any time.

➢ I understand that no employee or representative of Community Alternatives 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. I also understand that all offers of employment are contingent upon proof of my identity, legal ability to work in the United States, successful completion of pre-employment screening and satisfactory reference checks.

➢ I authorize Community Alternatives to investigate any information, including my employment history, educational background, credit history and record of criminal convictions that it believes is relevant to my employment application. My former employers, education institutions, and personal references may provide information that they may have about me in response to inquiry from Community Alternatives. I also understand that any offer of employment is conditioned on the completion of pre-employment tests, background checks and documentation. I will, upon request, sign all necessary consent forms.
Digital Signature
I understand that all inquiries on this application must be completed and if any inquire is left blank, my application will be rejected. I also acknowledge that I have read and understand all of the above statements and hereby grant permission to confirm the information supplied on this application by me.
Signature Date*
MM slash DD slash YYYY
Signature*
CAPTCHA

Employment Application

Personal Information

EMPLOYMENT HISTORY

Education

References

Skills & Qualifications

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY

Digital Signature

501 (c)(3)