Employment Application- Assessment and Training Counselor

Applicant Information

Date

Name*

First Last

What position(s) are you applying for?

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

How did you learn about Search for Change, Inc.

If you are under 18 years of age, can you provide required proof of your eligibility to work?*

Yes

No

Have you ever filled out an application with us before?*

Yes

No

If Yes, give dates:

If yes, give dates:

List friends or relatives working at Search for Change

Are you currently employed?

Yes

No

May we contact your current employer?

Yes

No

Are you approved to work in the United States?*

Yes

No

Proof of citizenship or immigration status will be required upon employment.

On what date would you be available to start work?

Are you available to work:

Full Time

Part Time

Relief Work

Overnight

Do you have a valid driver's license?

Yes

No

If yes, License State and Number

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, religion, ethnicity, gender, sexual orientation, age, marital status, national origin, citizenship, mental or physical disability or veteran status.

1. Name of Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Job Title

Name of Supervisor

Reason for leaving

Work performed

Date started

Date ended

2. Name of Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Job Title

Name of Supervisor

Reason for leaving

Work performed

Date started

Date ended

3. Name of Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Job Title

Name of Supervisor

Reason for leaving

Work performed

Date started

Date ended

4. Name of Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Job Title

Name of Supervisor

Reason for leaving

Work performed

Date started

Date ended

Education/Training

High School

Name and address of school

Course of study

Years completed

Diploma/Degree

Undergraduate/College

Name and address of school

Course of study

Years completed

Diploma/Degree

Graduate/Professional

Name and address of school

Course of study

Years completed

Diploma/Degree

Military Training

Untitled

Diploma/Degree

List any current professional licenses or certificates that you have.

Describe any speicalized training, apprenticeship, job-related skills acquired. Include any type of machinery, office equipment and computer skills.

List professional, trade, business or civic activities and offices held.

Please answer the following questions.

This position requires proficient writing skills. Please complete the following samples to showcase your writing abilities for this position. Writing samples must be 4-8 sentences.

Please write a short essay (4-8 sentences) about what skills you bring to this job.*

Please write a short essay (4-8 sentences) on "What does mental illness mean to me?"*

Please upload your resume.*

Max. file size: 100 MB.

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation the activities involved in the job or occupation for which you have applied?

Note to applicants: Do not answer this question unless you have been informed about the requirements of the job for which you are applying.

Yes

No

Applicant's Statement*

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment is at-will for an indefinite period unless terminated at any time by the employee or Search for Change, Inc.

I understand that no employee or representative of the agency, other than the Chief Executive Officer, has any authority to enter into an employment contract or to change the at-will employment relationship, or to make any agreement contrary to the foregoing.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of Search for Change, Inc.

Join the dedicated staff at Search for Change and make a difference today!

Applicant Information

Employment Experience

Education/Training

Please answer the following questions.