ACHIEVING BETTER COPING SKILLS LLC
EMPLOYMENT APPLICATION
Your Contact Information
First Name
Last Name
E-mail Address
example@example.com
Date of Birth
-
Month
-
Day
Year
Date
Cell Phone
Last Four of your Social Security Number (This number will be your Company 4 digit Pin)
Which position are you applying for?
Please Select
Direct Care Staff
Youth Transporter
What is your experience working with Group Home Children or At-Risk Youth?
What is your experience with Administration Duties?
List any languages you can speak fluently:
Work Experience and Previous Employer (For the past 10 years starting with your most recent)
Job Title
Company Name
Supervisor Name and Title
example@example.com
Supervisor Phone
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Job Description: Include duties, work schedule, etc.
Reason for leaving:
Work Experience #2
Job Title
Company Name
Supervisor Name and Title
example@example.com
Supervisor Phone
Job Description: Include duties, work schedule, etc.
Reason for leaving:
Work Experience #3
Job Title
Company Name
Supervisor Name and Title
example@example.com
Supervisor Phone
Job Description: Include duties, work schedule, etc.
Reason for leaving:
Work Experience #4
Job Title
Company Name
Supervisor Name and Title
example@example.com
Supervisor Phone
Job Description: Include duties, work schedule, etc.
Reason for leaving:
Work Experience #5
Job Title
Company Name
Supervisor Name and Title
example@example.com
Supervisor Phone
Job Description: Include duties, work schedule, etc.
Reason for leaving:
EDUCATION (Click all the has been completed)
High School / GED
Associates Degree
Bachelors Degree
Master"s Degree
Vocational Training
Other
NAME OF HIGH SCHOOL
NAME OF COLLEGE(S)
What is your expected Hourly Rate?
When can you start?
-
Month
-
Day
Year
Date
What is your availability?
Weekends 9am-9pm
Weekends 9pm-9am
Weekdays 9am-5pm
Weekdays 3pm-11pm
Weekdays 9pm-9am
Other
Check all documentation you can provide:
Fingerprint Clearance Card
CPR
First Aid
CIT / Jireh / CPI training
High School / GED diploma
College Diploma or Credits
AZ Driver's License
Auto Insurance
Physical (within 2 years)
Drug Test
Driving Record
Please check all that apply to your legal history
Convicted of a Felony
DUI or DWI
Current Suspended License
Unable to work with Children
Smoke Cigarettes
Smoke Marijuana
Use any form of Drugs
Drink Alcohol
Health Conditions
Taking Prescription Medication
Please explain in detail of any checked marks of your legal history above:
Signature
*
REFERRED BY ABC EMPLOYEE
NO
YES (Include Name)
TODAY"S DATE
-
Month
-
Day
Year
Date
Submit
Should be Empty: