Employment Application

APPLICANT INFORMATION
Last Name   First Name  M.I.  Date    Street Address  Apartment/Unit #  City   State  ZIP  Phone   E-mail Address    Date Available   Social Security No.  Desired Salary  Position Applied for  Are you at least 18 years of age?  Yes No  Are you a citizen of the United States?  Yes No If no, are you authorized to work in the U.S.? Yes No  Have you ever worked for this company?  Yes No If so, when?  Have you ever been convicted of a felony?  Yes No If yes, explain
* You must NOT list:   1. Convictions related to marijuana more than two years ago,   2. Convictions which have been judicially sealed, expunged or statutorily, including convictions during which you were a minor,   3. Misdemeanor convictions for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed,   4. Any information concerning a referral to, and participation in, any pretrial or post trial diversion program.
Are you available to work FT or PT? FT PT
The position requires your schedule to remain flexible.  Are you able to fulfil this  requirement? Yes No
Do you have a valid driver’s license? Yes No  Do you have current auto insurance? Yes No
Were you referred to Creative Solutions? Yes No  By who?
Are you bilingual? Yes No  What languages?

EDUCATION
High School  Address
From  To  Did you graduate? Yes No  Degree
College  Address
From  To  Did you graduate? Yes No  Degree
Trade  Address
From  To  Did you graduate? Yes No  Degree

REFERENCES - PLEASE LIST THREE PROFESSIONAL REFERENCES.
Full Name  Relationship
Company  Phone
Address
Full Name  Relationship
Company  Phone
Address
Full Name  Relationship
Company  Phone
Address

PREVIOUS EMPLOYMENT
Company  Phone
Address  Supervisor
Job Title  Starting Salary $   Ending Salary $
Responsibilities
From  To    Reason for Leaving
May we contact your previous supervisor for a reference? Yes No
Company  Phone
Address  Supervisor
Job Title  Starting Salary $   Ending Salary $
Responsibilities
From  To    Reason for Leaving
May we contact your previous supervisor for a reference? Yes No
Company  Phone
Address  Supervisor
Job Title  Starting Salary $   Ending Salary $
Responsibilities
From  To    Reason for Leaving
May we contact your previous supervisor for a reference? Yes No

AVAILABILITY – PLACE AN “X” IN THE TIME SLOTS YOU ARE AVAILABLE TO WORK
Monday  Tuesday  Wednesday  Thursday  Friday  Saturday  Sunday MORNING AFTERNOON EVENING

There are several aspects of employment with Creative Solutions for Hope which you should be aware of before completing this Application for Employment. Please read the following statements. I expressly agree and understand that my employment, having no specified term, is based upon mutual consent and may be terminated at will, with or without cause or notice, by either party (Creative Solutions or me). I also understand that this at-will aspect of my employment, which includes Creative Solutions’ right to demote, transfer or otherwise discipline me with or without cause or notice, may not be changed, waived or modified, except in an individualized written agreement signed by both me and the owner of Creative Solutions.

Please sign your initials in the box

Creative Solutions maintains a drug-free workplace in accordance with its Drug and Alcohol Policy and Screening Program. As a condition of employment with Creative Solutions, and after an offer of employment has been extended to you, you must successfully complete a physical examination and a drug and alcohol screening test. In addition, Creative Solutions reserves the right to administer a physical examination or a drug or alcohol screening test to any and all employees at any time during their employment, for cause as determined by the Company.

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Creative Solutions requires that you immediately notify the Company if you have been convicted of any crime while your job application is pending or, if hired, during your employment. Your failure to comply with this requirement may prevent your hire or, if hired, may result in immediate termination of your employment by Creative Solutions. *You must not list (1) convictions related to marijuana more than two years ago, (2) convictions which have been judicially sealed, expunged or statutorily eradicated, including convictions during which you were a minor (3) misdemeanor convictions for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed, (4) any information concerning a referral to, and participation in, any pretrial or post trial diversion program.

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Creative Solutions may seek to verify the information you have provided in this Application for Employment. By signing below, you acknowledge your understanding that Creative Solutions, its parent, subsidiaries, affiliates and any of its (their) employees or agents (collectively referred to as the Company) will require you to execute a stand-alone disclosure form authorizing and releasing the Company to contact the persons or organizations you have listed and to discuss your background with them.

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I understand that, if I become employed by Creative Solutions, I will be subject to and expected to comply with all the rules, regulations and procedures of the Company.

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You further acknowledge and represent that you are not subject to any non-competition agreement or other agreement that would prevent or impede in any way your employment with Creative Solutions. If you believe you may be, or may have been, a party to an agreement not to compete against any past employer, you must disclose the existence, or potential existence, of such agreement to Creative Solutions’ Human Resources department for further assessment.

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I understand that the hiring process is not complete and I will not become an employee of the Company until I have reviewed, completed and executed various employment documents including, but not limited to, this Application, the Company's Employee Handbook and Employee Handbook Acknowledgment Form, Arbitration Agreement, Consent and Disclosure Regarding Procurement of Consumer Credit Report and for Investigative Consumer Report and an At-Will Employment and Confidentiality Agreement.

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I declare under penalty of perjury that all of the information which I have provided on this Application for Employment or any resume or other documentation provided by me in connection with this Application for Employment is true and complete, and I understand that if any of the information is determined to be false, even if that determination is made years later, it will result in my immediate discharge from employment with the Company.

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I understand and agree to the foregoing provisions.

Please sign your initials in the box

DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge.  If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature   Date

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