Employment Opportunities

*Applicants MUST complete entire application. Any part not completed will be grounds for non-consideration.

Position Applying For*

Application Date*

Personal Information

Name

Salutation

Mr.

Mrs.

Miss

Ms.

First Name*

Middle Name*

Last Name*

Phone Numbers

Home*

Cell*

Work*

Address

Address*

Email*

When Will You Be Available To Begin Work?*

Are You Available For Full-Time Work?*

Yes

Are You Willing To Work Part-Time?*

Yes

Expected Salary?*

Military Service

Branch of Service

Date(s) of Service

Type of Discharge

Duties/Training:

Education

Highschool

Address

Graduation Date

Diploma/Degree/Major

Technical School

Career And Technical School

Address

Graduation Date

Diploma/Degree/Major

College - Undergraduate

Address

Graduation Date

Diploma/Degree/Major

College - Graduate

Address

Graduation Date

Diploma/Degree/Major

List any additional skills/training you possess which could be considered beneficial to the position for which you are applying. If you currently hold a teaching license, list areas of license as written o your teaching license.

Employment History

If presently employed, may we contact your employer?*

Yes

Job 1

Company

Supervisor

Type of Business

Position

Address

Date of Employment

Date

Duties

Reason For Leaving

Job 2

Company

Supervisor

Type of Business

Position

Date of Employment

Date

Address

Duties

Reason For Leaving

Job 3

Company

Supervisor

Type of Business

Position

Date of Employment

Date

Address

Duties

Reason For Leaving

Equal Opportunity Policy

Central Nine Career Center does not discriminate on the basis of race, color, religion, gender, national origin, age or individuals with disabilities, including limited English proficiency, in its programs or employment policies as required by the Indiana Civil Rights Act (I.C.22-9.1), Title VI and VII (Civil Rights Act of 1964), the Equal Pay act of 1973, Title IX (Educational Amendments), and Section 504 (Rehabilitation Act of 1973). Inquiries regarding compliance with title IX and Section 504 may be directed to the Director, Central Nine Career Center, 1999 US 31 South, Greenwood, IN 46143, 317-888-4401.

Authorization And Release Of All Claims

I authorize Central Nine Career Center to check my employment history, without limitation, including reference checks, and to seek the release of investigatory information, including an agency. I authorize these private or public employers or local, state or federal agency to provide Central Nine any information they may have concerning the matters described herein, and I will cooperate to the extent necessary to obtain the release of this information. In connection with any request for or the providing of such information, I expressly release Central Nine, its officials, employees, trustees and agents and any provider of such information from any and all claims, demands, costs, expenses and causes of action including without limitation defamation, infliction of emotional distress, invasion of privacy or interference with contractual relations.

Background Information

Are you presently being investigated or under a procedure to consider your discharge for misconduct by your present employer?*

Yes

Have you ever been reprimanded, disciplined, discharged or asked to resign from a prior position?*

Yes

Have you ever resigned from a prior position without being asked, but under circumstances involving your employer’s investigation or sexual conduct with another person, mishandling of funds or criminal conduct?*

Yes

Have you ever been charged with or investigated for physical or sexual abuse of another person?*

Yes

Have you ever been charged with, pleaded “guilty” or “no contest”, or been convicted of any crime involving sexual abuse or any other crime of moral turpitude?*

Yes

Have you ever been convicted of a misdemeanor or felony or ever entered a plea of “guilty” or “no contest”, or has any court ever deferred further proceedings without entering a finding of guilty or placed you on probation for any crime?*

Yes

If you answered yes to any one of the previous six (6) questions, please attach a written explanation, including the date of the incident, charges, any court action, the offense in question and the address of any court involved. Please note that criminal convictions that have been lawfully expunged are not required.

Authorization And Release Of All Claims

I hereby authorize you to release to Central Nine Career Center, Greenwood, Indiana, any and all personal and employment records pertaining to my employment by your company, including but not limited to, my application for employment, work records and performance evaluations. I also authorize the Indiana State Police, the Police Department, County Sheriff’s Department or the Federal Bureau of Investigation to release to Central Nine Career Center files pertaining to me.

I have read this authorization and release of all claims, and I expressly agree to the terms set out herein and in sections VI and VII of this application. I also understand that falsification of facts on this application shall be considered sufficient cause for disqualification or dismissal. References and personal information which become part of this record are to be regarded as confidential and will not be revealed.

Note: A photocopy of this authorization shall be as valid and binding as the original.

Signature*

Date*

Date Of Birth*

Professional References (REQUIRED)

Person 1

Name

Employer

Title

Telephone

Address

City

State

Zip Code

Person 2

Name

Employer

Title

Telephone

Address

City

State

Zip Code

Person 3

Name

Employer

Title

Telephone

Address

City

State

Zip Code

Personal Reference (OPTIONAL)

Name

Employer

Title

Telephone

Address

City

State

Zip Code

Cover Letter

Upload Cover Letter

Max. file size: 64 MB.

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