Employment

Helpful Stars Community Services

APPLICATION FOR EMPLOYMENT

Federal and State laws prohibit discrimination in employment because of sex, race, creed, religion, national origin, age, handicap, marital status, status with regard to public assistance or veterans’ employment. We are an equal opportunity employer.

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PERSONAL INFORMATION

Name
Are you legally entitled to work in the United States?
Are you at least 18 years of age?

In Case of Emergency Notify

Present Membership in National Guard or Reserves?

EMPLOYMENT DESIRED

Position:
Do you have a current Driver’s License?
Do you currently have a car?
Do you have active insurance?
Have you ever applied to this Company before?

PROFESSIONAL LICENSES, CERTIFICATION, AND REGISTRATIONS

Do you have any professional licenses, certifications and/or registrations?

REFERENCES

Give below the names of three work related references

EDUCATION

NAME AND LOCATION OF SCHOOL

Graduated
Graduated
Graduated
Graduated

FORMER EMPLOYERS

List below your complete employment history for the last five years, starting with the most recent position first. Attach additional pages if necessary.

May we contact?
I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for rejection or dismissal. Further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time, with or without cause, and with or without any prior notice.

VOLUNTARY SELF-IDENTIFICATION INFORMATION

Helpful Stars Community Services is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to sex, race, color, national origin or ancestry, age, handicap, marital status, source of income, class, physical characteristics, sexual orientation or political beliefs.

As an employer, we comply with government regulations and affirmative action responsibilities. Solely to help us comply with government record keeping, reporting and other legal requirements, please complete this Voluntary Self-Identification Information form. This data is for analysis and affirmative action only and submission of this information is voluntary. This data will be kept in a confidential file separate from your Application for Employment.

Gender
Veteran Status
Race/Ethnic Background
Disability Status
* According to the American with Disabilities Act, the term “disability” means, with respect to an individual, a physical or mental impairment that substantially limits one or more of the major life activities of that individual, a record of such an impairment, or being regarded as having such an impairment.
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