Application for Employment

Please complete the following application in its entirety. All questions must be answered even when submitting a resume.

Employment Desired

Today's Date *

Position

Interested In Full or Part Time? *

Full Time

Part Time

When Are You Available to Start Work If Hired? *

Personal Information

First Name *

Last Name *

Date of birth *

Address *

City *

State *

Email *

Home Phone

Cell Phone *

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from company in regards to a position at Oxnard Family Circle. Message frequency varies. Message & data rates may apply. Text HELP to (805) 952-7135 for assistance. You can reply STOP to unsubscribe at any time.

Education

Name of High School *

Did You Graduate High School *

Yes

University/College *

How Many Credits Earned *

Did You Graduate College? *

Yes

Degree Received *

Please let us know if you've earned any other degrees or certifications below.

Emergency Contacts

Emergency Contact 1:

Full Name *

Relationship *

Phone Number *

Emergency Contact 2

Full Name *

Relationship *

Phone Number *

Emergency Contact 3

Full Name *

Relationship *

Phone Number *

Employment History & Information

List all employment history from the last 10 years. List the most recent employer first and account for any gaps in employment.

May we contact your present employer?

Yes

If no, please explain why:

Most Recent/Present Employer

Company Name *

Address *

Phone *

Supervisor *

Job Title *

Time Period Employed *

Specific Duties *

Reason for Leaving *

Employer 2

Company Name *

Address *

Phone *

Supervisor *

Job Title *

Time Period Employed *

Specific Duties

Reason for Leaving *

Employer 3

Company Name

Address

Phone

Supervisor

Job Title

Time Period Employed

Specific Duties

Reason for Leaving

Employer 4

Company Name

Address

Phone

Supervisor

Job Title

Time Period Employed

Specific Duties

Reason for Leaving

Other Information

Are you authorized to work in the United States?

Yes

Are You Able to Pass a Background Check?

Yes

How did you learn about his position?

Newspaper

Referred By Employee

Other

If an employee referred you, who was it?

If you found us somewhere else, where did you find the position?

Why do you want to work with the Elderly and Impaired at Oxnard Family Circle?

Can You Type?

Yes

If you type, how many WPM?

Can You Operate a Computer?

Yes

What Computer Software are You Familiar With?

MS Word

MS Excel

MS PowerPoint

Other

If you checked other software, what other software? (Please list)

List any other business or office skills:

References

Reference 1

Address *

Full Name *

Daytime Phone *

Nighttime Phone *

Reference 2

Full Name *

Address *

Nighttime Phone *

Daytime Phone *

Reference 3

Full Name

Address

Nighttime Phone

Daytime Phone