Family Connection Application for Employment

Family Connection, Inc. is an Equal Employment Opportunity Employer committed to excellence through diversity. Employment offers are made on the basis of qualifications, and without regard to race, sex, religion, national or ethnic origin, disability, age, veteran status, or sexual orientation.

Complete the entire application.

Applications with missing information will not be considered.

Position Applying For:

Personal Information

Name(required)

Other names under which you have attended school or been employed:

Street and/or mailing address:(required)

City, State & Zip:(required)

Social Security Number:

Email(required)

Home Phone:

Work Phone:

Cell Phone:(required)

Date you can start work

Salary desired:

Are you authorized to work in the United States?(required)

Are you authorized to work in the United States? Yes

Are you 18 years of age or older?(required) Yes

Have you ever been employed by Family Connection?(required) Yes

If YES, dates of employment & reason for leaving:

Are you related to any current Family Connection employee or board director? Yes

If YES, their name & their relationship to you?

Do you have a valid Alabama driver’s license?(required) Yes

If YES, license #, and expiration date:

EDUCATION

Name of School High School/GED:

City/State

did you graduate? Yes

If No, # of years left to graduate

If Yes, date of Graduation

Degree received

Major

Other School:

City/State

did you graduate? Yes

If No, # of years left to graduate

If Yes, date of Graduation

Degree received

Major

College 1:

City/State

did you graduate? Yes

If No, # of years left to graduate

If Yes, date of Graduation

Degree received

Major

College 2:

City/State

did you graduate? Yes

If No, # of years left to graduate

If Yes, date of Graduation

Degree received

Major

Other credentials/ licenses/ professional affiliations, etc., which are relevant to the job(s) for which you are applying.

SKILLS: Please list technical skills, clerical skills, trade skills, etc., relevant to this position. Include relevant computer systems and software packages of which you have a working knowledge, and note your level of proficiency (basic, intermediate, expert)

WORK EXPERIENCE-Please detail your work history. Begin with your current or most recent employer.

First Position – Dates Employed (most recent position) From:

First Position – Dates Employed (most recent position) To:

First Position – Full or Part Time Full-time

Part-time

First Position – Position Title

First Position – Starting Salary:

First Position – Final Salary:

First Position – Organization Name and Address:

First Position – Supervisor’s Name:

First Position – Supervisor’s Phone Number:

First Position – May we contact this employer? Yes

First Position – Primary duties:

First Position – Reason for Leaving:

Second Position – Dates Employed (Second most recent position)From:

Second Position – Dates Employed (Second most recent position)To:

Second Position – Full or Part Time Full-time

Part-time

Second Position – Position Title

Second Position – Starting Salary:

Second Position – Final Salary:

Second Position – Organization Name and Address:

Second Position – Supervisor’s Name:

Second Position – Supervisor’s Phone Number:

Second Position – May we contact this employer? Yes

Second Position – Primary duties:

Second Position – Reason for Leaving:

Third Position – Dates Employed (Third most recent position)From:

Third Position – Dates Employed (Third most recent position)To:

Third Position – Full or Part Time Full-time

Part-time

Third Position – Position Title

Third Position – Starting Salary:

Third Position – Final Salary:

Third Position – Organization Name and Address:

Third Position – Supervisor’s Name:

Third Position – Supervisor’s Phone Number:

Third Position – May we contact this employer? Yes

Third Position – Primary duties:

Third Position – Reason for Leaving:

PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION.
I certify that the information on this application and its supporting documents is accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later date. I authorize Family Connection to investigate, without liability, all statements
contained in this application and supporting materials. I authorize references and former employers, without liability, to make full response to any inquiries in connection with this application for employment. If requested,

I agree to submit to a physical exam, criminal and credit background investigation, and/or screening for illegal substances upon conditional offer of employment. I understand that this document is NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that staff employee of Family Connection serve at-will, and the employment relationship may be terminated at any time by either party, or any or no reason, other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the United States and to comply with Family Connection policies. I understand that any benefits I receive may be
subject to change or discontinuation at any time without prior notice. I understand that the first Six Months of regular employment represents a probationary period.

Type your name as you signature(required)

Date(required)