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2. Contact Information
4. First Name*
5. Last Name*
7. Email Address*
8. Phone Number*

12. Employment Application

    
    

    Anthem Community Council is an equal opportunity employer and does not discriminate on the basis of race, color, gender, religion, age, marital status, sexual preference, sexual orientation, language, ancestry, medical condition(s), disability, national origin, or any other category protected by law. Those applicants who will require reasonable accommodations in the interview process should contact the Human Resources Department of the Anthem Community Council.

14. Personal Information
16. Date
18. Address*
20. City*
21. State*
22. Zip Code*
24. Are you eligible for employment in the USA? *

    1. Yes
    2. No
26. Do you meet the minimum age requirements for the position?*

    1. Yes
    2. No
28. Have you ever been convicted of a felony? *

    Disclosure of a criminal record does not automatically disqualify you from employment consideration. If yes, you must attach a summary of details including the nature of conviction, date and details of what occurred and any mitigating circumstances.

30. Employment Desired
32. Position applying for*
33. Rate of expected pay*
35. Have you previously been employed by us?*
36. If yes, when?
38. Scheduling Availability
40. I am interested in*

    1. Full Time
    2. Part Time
    3. Full Time, but will accept Part Time
42. I am available *

    1. Immediately
    2. Specific Date
43. If specific date, enter starting date here
47. Days Available

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
    6. Saturday
    7. Sunday
49. Time Available

    Please list the Earliest and Latest Time available for each day of the week. List 'Any Time' if you do not have time restrictions. 

53. Education

55. High School

57. Name & Location of School
58. No. of Years Attended
59. Diploma/Degree/Certification

61. College

63. Name & Location of School
64. No. of Years Attended
65. Diploma/Degree/Certification

67. Post Graduate

69. Name & Location of School
70. No. of Years Attended
71. Diploma/Degree/Certification

73. Trade, Business, Correspondence School

75. Name & Location of School
76. No. of Years Attended
77. Diploma/Degree/Certification
81. Military Service Record
83. If you were in the US Armed Forces, please complete the following:
85. Branch
87. Dates of Duty: From
88. Dates of Duty: To
90. Rank at Discharge
91. Reason for Discharge
95. FORMER EMPLOYERS (List last three employers below, starting with most recent.)
97. Employer
99. Name*
100. Address*
101. Phone*
103. Dates Employed (MM/YYYY-MM/YYYY)
104. Part Time or Full Time

     1. Full Time
     2. Part Time
105. Average Hours Per Week
107. Starting Salary $
108. Ending Salary $
109. Position
111. Duties
112. Reason for Leaving
114. Employer
116. Name*
117. Address*
118. Phone*
120. Dates Employed (MM/YYYY-MM/YYYY)
121. Part Time or Full Time

     1. Part Time
     2. Full Time
122. Average Hours Per Week
124. Starting Salary $
125. Ending Salary $
126. Position
128. Duties
129. Reason for Leaving
131. Employer
133. Name*
134. Address*
135. Phone*
137. Dates Employed (MM/YYYY-MM/YYYY)
138. Part Time or Full Time

     1. Part Time
     2. Full Time
139. Average Hours Per Week
141. Starting Salary $
142. Ending Salary $
143. Position
145. Duties
146. Reason for Leaving
148. I hereby give the Anthem Community Council permission to contact the following employers, from the list above, concerning any information that the organization deems relevant (list only employers that you give us permission to contact).
152. Skills and Additional Information
154. Special Skills (Please check all that apply)

     1. 10 Key by Touch
     2. Accounts Payable
     3. Accounts Receivable
     4. Business Writing
     5. Certified in First Aid
     6. Collections
     7. Construction
     8. Creative Writing

     1. Customer Service
     2. Electrical
     3. General Accounting
     4. Graphic Design
     5. Microsoft Excel
     6. Microsoft Word
     7. Office Phone Equipment
     8. Payroll

     1. Plumbing
     2. Pool Maintenance
     3. Prezi/Microsoft Powerpoint
     4. Project Management
     5. Property Management
     6. Sports/Aquatics
     7. Typing High WPM
     8. Youth Programs
156. Describe any certifications, foreign languages, training or experience that especially qualify you for the position for which you are applying.
158. Describe any special skills that especially qualify you for the position for which you are applying.
162. References
164. Reference One
166. Name*
167. Relationship*
169. Phone Number*
170. Email
172. Reference Two
174. Name*
175. Relationship*
177. Phone Number*
178. Email
180. Reference Three
182. Name*
183. Relationship*
185. Phone Number*
186. Email
188. Do you have any friends or relatives who currently work for the Anthem Community Council?

     1. Yes

     1. No
190. If yes, please fill in the following information
192. Name
193. Position/Location
194. Relationship
196. Name
197. Position/Location
198. Relationship
202. Cover Letter/ Resume Upload
204. Cover Letter Upload
206. Resume Upload
210. Please Read and Sign Below
212. Signature*

     I certify that the 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 an employment decision. I hold the Anthem Community Council, its representatives and all references harmless and release all parties, including all agents, employees and representatives of the Anthem Community Council and the referenced individuals named above and their Companies, from any and all liability of any type or nature for any damages that may result from obtaining such relevant information.

      

     This application for employment shall be considered active for a period of time not to exceed 30 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 relationship with this organization is “at will” in nature. I understand that this means that if hired, my term of employment is not for any definitive period of time, and I further understand that my employment with the Anthem Community Council does not provide any guarantee of continued employment or lifetime security. I understand that any employee of the Anthem Community Council can voluntarily terminate their employment at any time for any reason. I understand that the Anthem Community Council can also terminate the employment relationship at any time with or without cause, for any reason, as long as that reason does not violate Federal or State laws. I understand that if offered a position at the Anthem Community Council, I will have to supply information to validate my ability to legally reside in the United States, my legal ability to apply for gainful employment within the United States and any and all requirements that this State and the United States Government may require within an employment environment.

      

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

214. By checking this box, you agree to receive SMS text messages from Anthem Community Council. Reply STOP to Opt-Out at any time. Messages and data rates may apply. Message frequency will vary. You agree to our Terms and Conditions and our Privacy Policy & Disclaimer.*

     1. Agree

     Privacy Policy & Disclaimer

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216. 1. Receive an email copy of this form.
217. Email address

     This field is not part of the form submission.

218. Submit

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