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Application For Employment

Name

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Address

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Previous address if current address is less than three (3) years:

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Telephone Numbers

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General Information

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All applicants will be required to complete a Criminal History Disclosure Form (A20) after the initial interview.

All applicants who will have regular and substantial unsupervised or unrestricted physical contact with people receiving services will be required to comply to criminal history record checks and/or fingerprinting.

Employment Data

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Employment History

Start with your present or last job. Include any job-related volunteer activities, summer and cooperative education assignments. Please account for all time for at least the past seven (7) years. (Resumes may not be used as a substitute)
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Education and Training

High School

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College

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Graduate School

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Trade, Business, Correspondence, Other

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Military Service

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References

List two personal references who can attest to your character, reputation and personal qualifications, who are not related to you:
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Driving History

Please complete this section only if the job for which you are applying requires a valid New York State driver's license and ability to drive a vehicle for job-related responsibilities.
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A driving record check will be done on all applicants who are applying for a job that requires a valid driver's license. Certain violations or combinations of violations may disqualify applicants from applying for certain positions.

Applicant Statement

I certify that all of the information furnished by me in this application is true and complete. I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for immediate dismissal if discovered at a later date. I also understand I will be required to provide proof of citizenship and employment eligibility at the time of employment.

I agree and authorize Catholic Charities Community Services to conduct a background inquiry to verify the information on this application, and I authorize all schools, previous employers, or other persons having knowledge of me or my records to release such information to Catholic Charities Community Services.

I further understand, if I am selected as a finalist for any position within the agency, they will do an investigation of criminal convictions which may include fingerprinting.

I hereby release those schools, employers, associations, agencies and persons, and Catholic Charities Community Services from all claims and liability whatsoever that may arise out of such disclosure or such investigations.

I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages or salary, be terminated at any time without prior notice.

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