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Employment Application - Step 2 of 2
Prevention Works is an equal opportunity employer and does not discriminate in recruitment, hiring or other terms or conditions of employment on the basis of race, color, religion, national origin, sex, disability, age or any other status protected by law.
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Indicates required field
Your Full Name
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Email
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Mailing Address
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Mobile Phone Number
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Online Posting? (Indicate Website)
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Are you 18 years of age or older? (If not, you may be required to provide work authorization.)
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Yes
No
If hired, can you provide verification of your legal right to work in the United States?
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Yes
No
Have you ever been convicted of a crime?
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Yes
No
A criminal record is reviewed as it is required for the work done in schools and with youth. A criminal record does not constitute an automatic bar to employment. Any record will be considered only as it is related to the job applying for.
If so, please explain...
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Have you applied with Prevention Works in the last year?
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Yes
No
HAVE YOU BEEN EMPLOYED WITH PREVENTION WORKS BEFORE?
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Yes
No
If yes, when were you employed with us and in what position?
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Do you have any relatives or household members currently working for Prevention Works? If so, please list their name and relationship to you.
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What type of employment do you seek?
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Full Time
Part Time
Temporary
Not Sure
Education Section
Education - High School
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In Progress
Diploma Awarded
None
Name of High School
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Name of College (if applicable)
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College Status
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Degree Awarded
Degree Not Awarded
Current Student
Employment Section
Begin with your present job and include the Employer name, Address, Dates Employed (from/to), Job Title
Work, Performed, Supervisor name,, Phone Number, and Reason for Leaving.
Employer #1 - City & State
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Reason for Leaving (#1)
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Include any work performed not noted on your resume.
Supervisor #1 - Name, Phone, & Email
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Dates Employed at Employer #1
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May we contact employer #1 above?
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Yes
No
Previous job #2
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Include the Employer name, Address, Dates Employed (from/to), Job Title Work, Performed, Supervisor name,, Phone Number, and Reason for Leaving
May we contact employer #2?
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Yes
No
Previous Job #3
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Include the Employer name, Address, Dates Employed (from/to), Job Title Work, Performed, Supervisor name,, Phone Number, and Reason for Leaving
May we contact employer #3?
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Yes
No
If necessary, please explain any gaps in your employment history.
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Note any job-related military service assignments and volunteer activities here.
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Include the Employer name, Address, Dates Employed (from/to), Job Title Work, Performed, Supervisor name,, Phone Number, and Reason for Leaving
Please provide two professional/work references and a personal reference. References should be unrelated to you and not live in your household. Do not include past employers. Include your relationship to the reference, phone number(s), and email.
Professional Reference #1
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Reference #1 - Relationship to you, phone #, email
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Please include phone and email.
Professional Reference #2
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Reference #2 - Relationship to you, phone #, email
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Please include phone and email.
Personal Reference
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Personal Reference Contact Info and Relationship to YOU!
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Please include phone and email.
I certify that all information provided by me in this application is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation, or omission of any facts in this application or any other document submitted in connect with Prevention Works employment will result in denial of employment or terminations of employment regardless of the timing or circumstance of discovery. I authorize Prevention Works and persons listed (references, schools, current (unless noted) and former employers and any others with who you desire to check) to communicated with regard to any relevant information that may be required to reach employment decision. I agree to hold such persons harmless with respect to any information they supply. I understand and agree that any offer of employment is contingent upon successful completion of all background check processes, including a criminal history background check. If I am employed by Prevention I understand my employment can be terminated, with or without cause and with or without notice, at any time at the option of Prevention Works or myself. I understand that, other than the CEO of the Prevention Works, no manager, supervisor or representative of Prevention Works has authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing. Only the CEO of Prevention Works has the authority to make any agreement contrary to the foregoing and then only in writing. I further expressly agree that, with respect to the at-will employment relationship, this constitutes the full, complete and final expression of the parties’ intent concerning the nature of any employment relationship between myself and Prevention Works. I understand that all offers of employment are conditional upon my ability to provide appropriate documents regarding my identity and legal right to work in the United States.
I understand that this application is only valid for the position applied for at present and that Prevention Works is not obligated to retain or consider this application for future openings. If hired, I agree to abide by Prevention Works policies and rules at all times. I acknowledge that I have read the above statements and understand them.
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Yes, I agree
I certify that all information provided by me in this application is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation, or omission of any facts in this application or any other document submitted in connect with Prevention Works employment will result in denial of employment or terminations of employment regardless of the timing or circumstance of discovery. I authorize Prevention Works and persons listed (references, schools, current (unless noted) and former employers and any others with who you desire to check) to communicated with regard to any relevant information that may be required to reach employment decision. I agree to hold such persons harmless with respect to any information they supply. I understand and agree that any offer of employment is contingent upon successful completion of all background check processes, including a criminal history background check. If I am employed by Prevention I understand my employment can be terminated, with or without cause and with or without notice, at any time at the option of Prevention Works or myself. I understand that, other than the CEO of the Prevention Works, no manager, supervisor or representative of Prevention Works has authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing. Only the CEO of Prevention Works has the authority to make any agreement contrary to the foregoing and then only in writing. I further expressly agree that, with respect to the at-will employment relationship, this constitutes the full, complete and final expression of the parties’ intent concerning the nature of any employment relationship between myself and Prevention Works. I understand that all offers of employment are conditional upon my ability to provide appropriate documents regarding my identity and legal right to work in the United States. I understand that this application is only valid for the position applied for at present and that Prevention Works is not obligated to retain or consider this application for future openings. If hired, I agree to abide by Prevention Works policies and rules at all times. I acknowledge that I have read the above statements and understand them.
Today's Date
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Electronic Signature
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Type your full name here.
Upon submission of this form, you will be redirected to a confirmation/thank you page. If you do not see that page, then your application process is NOT complete. Please ensure that you've completed all the required steps as indicated by the asterisk.
Submit
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>
Vaping-Documents
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Underage Drinking
Community Reports
>
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