Application for Employment

Posted Position Job Opening Title:

Personal Information

Full Name:

Telephone:

Home

Address:

Cell

Social Security #

Resident County:

Name of any relative employed with YVEDDI:

Position:

Name of any relative on Board of Directors or a Policy Council:

Kinship:

Previous employment with YVEDDI:

    Yes    No

Position

Dates

Position

Dates

Referred by:

Travel

Travel in safe personal vehicle is required for most positions.

N.C. Drivers License #

Residence in District or County may be required. Can you re-locate?  Yes      No

Education and Training

School & Location

Major Course of Study

Years Completed

Graduate?

Degree Type

High School

Technical

College

Graduate

Military

Describe special skills (machines, repairs, counseling, etc)

Employment Experience

Start with most current.

May we contact?   Yes        No

Employer:

Supervisor:

Address:

Telephone:

Duties:

Job Title:

Dates Employed:

Reason for Leaving:

Last Pay Rate Per Hour:

May we contact?  Yes        No

Employer:

Supervisor:

Address:

Telephone:

Duties:

Job Title:

Dates Employed:

Reason for Leaving:

Last Pay Rate Per Hour:

May we contact?  Yes        No

Employer:

Supervisor:

Address:

Telephone:

Duties:

Job Title:

Dates Employed:

Reason for Leaving:

Last Pay Rate Per Hour:

May we contact?  Yes        No

Employer:

Supervisor:

Address:

Telephone:

Duties:

Job Title:

Dates Employed:

Reason for Leaving:

Last Pay Rate Per Hour:

References

Please submit COMPLETE addresses.

(List non-related local persons that we can contact)

Name:

Name:

Address:

Address:

Telephone:

Telephone:

Email Address:

Email Address:

Name:

Name:

Address:

Address:

Telephone:

Telephone:

Email Address:

Email Address:

Before final job offer is made, some or all of the following may be required.

1.       Satisfactory Pre-employment affidavit required for no illegal on-the-job Drug Abuse.

2.      Satisfactory Pre-employment affidavit required for Child Abuse, Neglect, and Family Domestic Violence required for certain jobs.

3.      Satisfactory Pre-employment, Random, and After Accident Testing for illegal drugs use required for certain jobs.

4.      Pre-employment report required for certain jobs regarding any felony convictions.

5.       Satisfactory Pre-employment Medical Examination and/or testing or immunizations required for certain jobs.

6.      Satisfactory Pre-employment negotiations required for determining accommodations for any disability.

7.      Satisfactory Pre-employment completion of I-9 form required to verify US citizenship of Legal Alien Resident status.

8.      Pre-employment verification of safe vehicle driving record for previous ten (10) years may be required for certain jobs.

Other information that would be helpful in considering this application:

Resume attached?  Yes     No

Affirmation

The information provided in this Application and any related attachment is true, accurate, and complete.

By Applicant:

Date: