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Employment Application
We are thrilled that you're considering joining our team!
Please complete the application then press "Apply."
Notice: This information will not be used for the purpose of discrimination. Employment and Advancement are determined by a person's qualifications and abilities without regard to race, creed, color, age, religion, sex, national original, disability or veteran status. The questions asked in the application are intended to comply fully with all applicable laws and regulations, and your responses should be governed by and construed in accordance with such laws and regulations.
All fields in this form are required. If something is not applicable to you please put N/A in the space.
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Which Position Are You Applying For?
Please select
JASPER House Mental Health Tech. (Pt)
Way Station Shelter Advocate (PT)
Living Well Outpatient Clinic Admin Assistant
Ascension Rapid Re-Housing Case Manager
Social Work Case Manager -- Mobile, AL
Medical Assistant (2) -- Mobile, AL
Van Driver
Prevention Outreach Lead
Living in Balance Chemical Addiction Program (LIBCAP) Therapist
Please select
How did you hear about this position?
Are you able to perform the tasks involved in the job for which you have applied with or without accommodations?
With
Without
First / Last name
Home Phone Number
Cell
Phone Number
Present Address
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Permanent Street
Address
(if different than present address
Email
Please Check "Yes" and all the content that applies to you correctly; otherwise, please select "No."
What is your current employment status?
Employed
Self-Employed
Unemployed
Student
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Are you over 18 yrs. of age?
Yes
No
Do you have a valid driver's license?
Yes
No
Are you a citizen of the United States?
Yes
No
Have you ever been convicted for violations of any laws other than minor traffic violations?
Yes
No
Have you ever worked for AIDS Alabama or an affiliated company before?
Yes
No
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Desired Salary
Desired salary for this position, ie 10/hr, 24k/year
Schedule
Please provide the work hours you will be available.
Are you able to work
Full-Time
Part-Time
Monday
available
limited
unavailable
Tuesday
available
limited
unavailable
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Wednesday
available
limited
unavailable
Thursday
available
limited
unavailable
Friday
available
limited
unavailable
Saturday
available
limited
unavailable
Sunday
available
limited
unavailable
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Emergency Contact Information
Name and contact information of a person, not already listed, who would most likely always know how or where to reach you.
Name and title
Title
Ms
Miss
Mrs
Mr
Title
Phone Number
Street
Address
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Educational Background
Highest Grade Level completed
Other
Other Schools and Special Training
High School Attended
Which do you have?
Diploma
GED
Neither
College(s) Attended
Degree(s)
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Military Service (Enter N/A if it doesn't apply to you)
Dates of Service
Branch of Service
Last Rank
Nature and Duties of any Special Training
Professional Licenses (Enter N/A if it doesn't apply to you)
License
State
Certificate Number
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Experience Record
List each company for whom you have worked in the last six years. Start with your present or most recent job and work backward.
Experience Record #1 (Enter N/A if it doesn't apply to you)
Name
Phone Number
Name of supervisor and email address
Reason for leaving
Street
Address
Start Date of employment
MM
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DD
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YYYY
End Date of employment
MM
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DD
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YYYY
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Job Title at start of employment
Job Title at end of employment
Duties performed
Experience Record #2
Name
Phone Number
Name of Supervisor and email address
Reason for leaving
Street
Address
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Start date of employment
MM
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DD
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YYYY
End Date of employment
MM
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DD
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YYYY
Job Title at start of employment
Job Title at end of employment
Duties performed
Experience Record #3
Name
Phone number
Name of supervisor and email address
Reason for leaving
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Street
Address:
Job Title at start of employment
Job Title at end of employment
Duties performed
Start Date of employment
MM
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DD
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YYYY
End Date of employment
MM
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DD
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YYYY
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Copy of Replace this with a title or description
Professional
References
Give names and addresses of persons other than relatives who have knowledge of your experience and ability. You must provide at least three (3).
#1 Reference Full name
Reference Email
Occupation
Street
Address
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#2 Reference Full name
Reference Email
Occupation
Street
Address
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#3 Reference Full name
Reference Email
Occupation:
Street
Address
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Add A Cover Letter
File upload
Delete all uploads
Choose files or drag here
Add Resume
File upload
Delete all uploads
Choose files or drag here
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Legal Releases
As part of this selection process: (Select the appropriate answer)
Do you have any objections to our contacting your past employers and academic institutions?
Yes
No
Do you agree to a criminal background check as a precondition of your employment?
Yes
No
Do you have any objections to our contacting your current employer prior to our deciding your suitability?
Yes
No
Are you prepared to furnish copies of all certificates, and letters of commendation?
Yes
No
The company is committed to providing a drug-free workplace and successfully completing a drug test is a precondition of employment. Are you prepared to undergo a pre-employment drug screening?
Yes
No
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Replace this with a title or description
All information contained in this application is true to the best of my knowledge and belief. Furthermore, I understand that any false statements or representations on my part will result in termination of contract or employment if contracted or employed; or constitute just able reasons for termination of discussion on possible contracts or employment. I have been advised that a routine investigation in connection with my possible engagement may be conducted. This investigation will check on my character, general reputation, personal characteristics, and mode of living.I understand that, as a condition of employment with AIDS Alabama. I will furnish proof of age, and citizenship or legal entry into the United States. I understand that I may be required at the option of AIDS Alabama, to apply for a US Security Clearance.I authorize all law enforcement, credit, educational institutions, employers, friends, neighbors, and business acquaintances to furnish the company or a third party a complete history of my record including (but not limited to) my character, habits, abilities, and I release each and the company from any and all liability for damages to me by reason of compliance with your request whether such be due to negligence or errors or any other cause. I further agree that AIDS Alabama. shall have the right, if and when my contract or engagement is terminated, to furnish others with information regarding my work record.
A description of the essential functions of the job will be provided for your review upon request.
Name
Date
MM
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Signature
Clear
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Verification
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