Employment Application 2018-05-15T12:05:29+00:00

AN EQUAL OPPORTUNITY EMPLOYER

Employees of the ESCSB and applicants for employment shall be afforded equal opportunity in all aspects of employment without regard to race,color, religion, political affiliation, national origin, disability, marital status, gender or age.

As a means of accommodation to persons with specific disabilities that prevent them from completing this application, confidential assistance in filling out this application may be obtained by calling the agency to which you are applying.

All fields marked with an asterisk (*) are required fields.

Job Information

Full legal name
Mailing address
Contact information

Education

a. The highest grade completed *
b. If you did not complete high school, do you have a high school equivalency diploma?
c. Select number of years of post high school education *
d. If you expect to complete an educational program in the near future, please indicate

Experience

Starting with the most recent, describe ALL paid, military and applicable voluntary experience. Highlight your knowledge, skills and abilities which best demonstrate your qualifications for this position. You may list significantly different jobs within the same organization as separate items.

Your name is different form present
Employer address
Salary
Dates
Your name is different form present
Employer address
Salary
Dates
Your name is different form present
Employer address
Salary
Dates
Your name is different form present
Employer address
Salary
Dates
Additional information you think would help us evaluate your application, including training, seminar, workshops and special achievements or specialized skills:
License(to include driver's), certificate or other authorization to practice a trade or profession

References

List names, addresses and relationship of three persons not related to you who know your qualifications:

Miscellaneous

When will you be available to start work? *
List the geographic locations in which you are willing to work *
For purposes of compliance with The Immigration Reform and Control Act, are you legally eligible for employment in the United States? *

Under the Immigration Reform and Control Act of 1986, you will be required to fill out a certification verifying that you are eligible to be employed and verifying your identity. Further, you will be required to provide documentation to that effect should you be employed.

Are you willing to provide your own transportation if necessary for your employment? *
For purposes of compliance with Section 2.1-112 of the Code of Virginia, have you ever served in the Armed Forces of the United States? *
If yes, please specify the dates:
Have you ever been convicted for any violation(s) of law, including moving traffic violations or juvenile convictions committed after your fourteenth birthday? *
Description of offence/nature of the crime
City, state and country of conviction

We collect responses to the questions below for record keeping purposes. This information will NOT be kept with your application for employment. Federal law prohibits unlawful discrimination on the basis of race, color, sex, age, national origin, religion, or disability.

Summary

Job Information
Position applied for
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Last name
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First name
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Middle name
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Address
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City
--
State
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Zip
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Home phone
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Business phone
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Email address
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Education
The highest grade completed
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If you did not complete high school, do you have a high school equivalency diploma?
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Select number of years of post high school education
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Name & location of institution
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Hrs
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Degree received
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Major or Specialty
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Minor
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Name & location of institution
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Hrs
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Degree received
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Major or Specialty
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Minor
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Name & location of institution
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Hrs
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Degree received
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Major or Specialty
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Minor
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Name & location of institution
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Hrs
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Degree received
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Major or Specialty
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Minor
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Type of degree or program
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Expected completion date
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Experience
May we contact your present supervisor?
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Job title
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Job type
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Duties
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Last name
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First name
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Middle name
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Number and titles of employees you supervised
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Equipment used
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Employer
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Address
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City
--
State
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Zip
--
Type of business
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Phone
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Immediate supervisor
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Title
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Salary Start($)
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Salary Finish($)
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From Date
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To Date
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Reason for leaving
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Job title
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Job type
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Duties
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Last name
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First name
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Middle name
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Number and titles of employees you supervised
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Equipment used
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Employer
--
Address
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City
--
State
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Zip
--
Type of business
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Phone
--
Immediate supervisor
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Title
--
Salary Start($)
--
Salary Finish($)
--
From Date
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To Date
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Reason for leaving
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Job title
--
Job type
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Duties
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Last name
--
First name
--
Middle name
--
Number and titles of employees you supervised
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Equipment used
--
Employer
--
Address
--
City
--
State
--
Zip
--
Type of business
--
Phone
--
Immediate supervisor
--
Title
--
Salary Start($)
--
Salary Finish($)
--
From Date
--
To Date
--
Reason for leaving
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Job title
--
Job type
--
Duties
--
Last name
--
First name
--
Middle name
--
Number and titles of employees you supervised
--
Equipment used
--
Employer
--
Address
--
City
--
State
--
Zip
--
Type of business
--
Phone
--
Immediate supervisor
--
Title
--
Salary Start($)
--
Salary Finish($)
--
From Date
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To Date
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Reason for leaving
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Additional information you think would help us evaluate your application, including training, seminar, workshops and special achievements or specialized skills:
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Automated word processing(specify equipment)
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Typing speed(per minute)
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Shorthand speed(words per minute)
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License Type
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Granted by(licencing board)
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License Type
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Granted by(licencing board)
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License Type
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Granted by(licencing board)
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License Type
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Granted by(licencing board)
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References
Name
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Address
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Phone
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Relationship
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Name
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Address
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Phone
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Relationship
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Name
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Address
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Phone
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Relationship
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Miscellaneous
Check which shift you will accept
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Specify shift hours
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Check which job status you would accept
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When will you be available to start work? (No date is necessary if you are available as soon as you give two (2) weeks' notice
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Are you willing to accept employment which requires you to travel?
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List the geographic locations in which you are willing to work
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For purposes of compliance with The Immigration Reform and Control Act, are you legally eligible for employment in the United States?
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Are you willing to provide your own transportation if necessary for your employment?
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For purposes of compliance with Section 2.1-112 of the Code of Virginia, have you ever served in the Armed Forces of the United States? If yes, please specify the dates: From:
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For purposes of compliance with Section 2.1-112 of the Code of Virginia, have you ever served in the Armed Forces of the United States? If yes, please specify the dates: To:
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Have you ever been convicted for any violation(s) of law, including moving traffic violations or juvenile convictions committed after your fourteenth birthday?
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The racial or ethnic group with which you identify
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Highest level of education you have completed
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Gender
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Date of birth
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How did you find out about this employment opportunity?
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Please specify name of Newspaper or other media, or explain "Other"
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Certification

I hereby certify that all entries on both sides and attachments are true and complete, and I agree and understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture on my part to any employment in the service of the Eastern Shore Community Services Board. I understand that all information on this application is subject to verification and I consent to criminal history background checks and applicable to position applied for a check of my driving record. I also consent to references and former employers and educational institutions listed being contacted regarding this application. I further authorize the Eastern Shore Community Services Board to rely upon and use, as it sees fit, any information received from such contacts. Information contained on this application may be disseminated to other agencies, nongovernmental organizations or systems on a need-to-know basis for good cause shown as determined by the agency head or designee.