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Pre-Employment Application

To: Community Action Partnership of the Greater Dayton Area - Human Resources Department
Topic: Online Pre-Employment Application
(review privacy policy)

Community Action Partnership of the Greater Dayton Area is an equal opportunity employer. All applicants are considered for employment without regard to race, religion, sex, national origin, color, age, marital or veteran status, the presence of a non-job-related medical condition or physical handicap, or any other status protected by federal or state law.

Please fill out the entire application; and explain answers thoroughly. Upon completing the application click Submit Application. Your application will be e-mailed to our office and will show if your qualifications are a good match for the position you are applying for. You may be contacted for further consideration. If you are not contacted immediately, we do maintain all applications/ resumes on file for a period of six months.

* Your online application will not process until all required fields are completed!

Acknowledgements

Agree to Acknowledgement and Consent *

Yes No Read Acknowledgement and Consent

Your Information

First Name *	Middle Initial
Last Name *
Address 1 *
Address 2
City *
State *	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming
Zip Code *
Phone *	- -
E-mail address *

Previous Addresses

1. Previous address *
Dates *	to
2: Previous address
Dates	to

Emergency Contact Information

Full Name
Complete Address
Phone	-  -

Education

High School Diploma or GED*	Yes No
Attend College *	Yes No  If yes, how many years?
What College did you attend?
List any courses you are now taking

Work Experience

Last or present employer *
Dates *	to
Employer complete address *
Supervisor name and title *
Salary *
Your position and basic duties *
Reason for leaving *
2. Employer
Dates	to
Employer complete address
Supervisor name and title
Salary
Your position and basic duties
Reason for leaving
3. Employer
Dates	to
Employer complete address
Supervisor name and title
Salary
Your position and basic duties
Reason for leaving

References

Please list 3 references with at least one professional reference
1. Reference Name*
Complete address *
Phone number *
Please indicate: *	Personal Professional
Years known *
2. Reference Name
Complete address
Phone number
Please indicate:	Personal Professional
Years known
3. Reference Name
Complete address
Phone number
Please indicate:	Personal Professional
Years known

U.S. Military Service

Branch of service
Rank at discharge
Honorable Discharge	Yes No
Give a brief description of special training received or most significant duty

Additional Information

Position applying for *
Valid Drivers license *	Yes No State of Issue Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming License #
Use car to get to work *	Yes No

Referral

How did you hear about us?

Search Engine (i.e. Google, Yahoo...) Link From Another Web Site Business Colleague or Acquaintance Alliance Partner Community Action Partnership of the Greater Dayton Area Client