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Position applying for:
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What date can you start?*
What category would you prefer? (click any that apply) *
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When are you available to work? (click any that apply)*
Weekdays
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Other
Comments:
Job Related Skills
Yes No
If the job requires, do you have a valid drivers license?*
Yes No
Do you understand the essential functions of this job?*
Yes No
Can you perform the essential functions of this job without reasonable accomodation?*
List languages in which you are fluent.
Please list skills, licenses, certificates, experiences, training or qualification that may be job-related
or that you feel would be of value to this job or company.
Education
Please list your education below. If the name on your school records are under a different name than listed above, please enter that name.
Have you ever been convicted of a crime? If so, please descibe in the boxes below. (You may omit convictions that have been sealed, expunged,
or legally erased, and marijuana-related offenses more than two-years old.) Conviction will not necesarily be a bar to employment; each case will be evaluated on
its own fact and circumstances.*
Yes
No
Personal Information
Yes No
Have you ever applied to or worked for Canine Companions for Independence before?*
If yes, when? (mm/dd/yyyy)
Yes No
Do you have any friends or relatives working for Canine Companions for Independence?*
If yes, state name and relationship:
Yes No
If hired, would you have a reliable means of transporation to and from work?*
Yes No
Are you at least 18 years old? (If under 18, hire is subject to valid work permit)*
Yes No
If hired, can you provide proof of your legal right to live and work in the United States?*
Yes No
Are you willing to relocate?*
Yes No
Have you ever been discharged or asked to resign from employment.*
If yes, please explain:
How did you hear about the job opening?*
Since we will make every effort to contact previous employers, the correct telephone numbers of past employees are critical. For employers outside the United States, a current fax number or email address is mandatory.
Previous Employers
Most Recent Employer
May we contact? Yes No
Company Name
Phone
Fax
Job Title
Date Employed
Duties
Supervisor Name
Salary/Rate of Pay
Reason for Leaving
Second Employer
May we contact? Yes No
Company Name
Phone
Fax
Job Title
Date Employed
Duties
Supervisor Name
Salary/Rate of Pay
Reason for Leaving
Third Employer
May we contact? Yes No
Company Name
Phone
Fax
Job Title
Date Employed
Duties
Supervisor Name
Salary/Rate of Pay
Reason for Leaving
Please explain any gaps in employment history:
References
Include only individuals familiar with your work ability. Do not include relatives.
Resume
Click here to attach file. (.doc .rtf .txt .pdf only)
Cover Letter
Click here to attach file
Certification and Release
Please read the information below and make sure the box is checked.
I hereby certify that the facts contained in this application are true and complete to the best of my knowledge. I further certify that I have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
I hereby authorize Canine Companions for Independence (CCI) to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any information related to my work records, without giving me prior notice of such disclosure. I hereby release CCI, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between CCI and me. In addition, I understand and agree that if I am employed, my employment is “at will,” which means that it may be terminated at any time, with or without prior notice, and with or without cause, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on CCI unless made in writing and signed by me and CCI’s Chief Executive Officer.
If hired, I agree to read and comply with all of CCI’s policies. I further understand that if employed, upon the separation of my employment, I will be required to return all CCI property in my possession.
I acknowledge I have read, understood, and agreed to the above statements, and certify under penalty of perjury that this application is true and correct.
By submitting this application electronically, I agree that the name on this application has the same effect as if I signed a hard copy of this application.
I agree *
Thank you for taking the time to fill out this form.