Application

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.

* Indicates required field

Your Full Name *

Email *

Mailing Address *

Mobile Phone Number *

Online Posting? (Indicate Website) *

Are you 18 years of age or older? (If not, you may be required to provide work authorization.) *

Yes No

If hired, can you provide verification of your legal right to work in the United States? *

Yes No

Have you ever been convicted of a crime? *

Yes No

If so, please explain... *

Have you applied with Prevention Works in the last year? *

Yes No

HAVE YOU BEEN EMPLOYED WITH PREVENTION WORKS BEFORE? *

Yes No

If yes, when were you employed with us and in what position? *

Do you have any relatives or household members currently working for Prevention Works? If so, please list their name and relationship to you. *

What type of employment do you seek? *

Full Time Part Time Temporary Not Sure

Education Section

Education - High School *

Name of High School *

Name of College (if applicable) *

College Status *

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 *

Reason for Leaving (#1) *

Supervisor #1 - Name, Phone, & Email *

Dates Employed at Employer #1 *

May we contact employer #1 above? *

Yes No

Previous job #2 *

May we contact employer #2? *

Yes No

Previous Job #3 *

May we contact employer #3? *

Yes No

If necessary, please explain any gaps in your employment history. *

Note any job-related military service assignments and volunteer activities here. *

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 *

Reference #1 - Relationship to you, phone #, email *

Professional Reference #2 *

Reference #2 - Relationship to you, phone #, email *

Personal Reference *

Personal Reference Contact Info and Relationship to YOU! *

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. *

Yes, I agree

Today's Date *

Electronic Signature *

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

Job Application

Employment Application - Step 2 of 2