Columbus Urban League | Employment Application

Employment Application

Please fill the form given below, or click here to download the printable version our Employment Application Form.

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	* Required Fields
*Name:
*Address:		*Email:
*City:		*State:
*Zip:		*Telephone:
Name Position(s) applied for:		Salary Requirements:
	Full Time Part Time
If Part Time, will you be available:	Morning Afternoon Early evenings
Have you filed an application here before?	Yes No	If yes, give date(s):
Have you ever been employed here before?	Yes No	If yes, give date(s):
Reason for leaving
If you are under 18 years of age, will you be able to furnish a work permit after employment?			Yes No
Do you have any relatives currently employed at the Columbus Urban League?			Yes No
If yes, Name:		Department:
How did you learn about this opening?

EDUCATIONAL DATA
School	Name & Location	No. of Yrs. Completed	Major Course of Study	Degree or Diploma
High School				Degree Diploma
College				Degree Diploma
Graduate				Degree Diploma
Business/ Trade				Degree Diploma
Other				Degree Diploma

In order to permit a check of your educational and work records, should we be made aware of any change of name or assumed name that you previously used?				Yes No
If yes, identify names and relevant dates
*Have you ever been convicted of a crime other than a traffic violation? (Conviction will not be an absolute bar to employment)				Yes No
If so, please state date, place and nature of the incident:

EMPLOYMENT DATA

Please give accurate, complete full-time and part-time employment record. Start with your present or most recent employer.

Employer:

Date:

From:

To:

Work Performed:

Hourly Rate/Salary:

Starting:

Final:

Address:

City:

State:

Zip:

Telephone:

Supervisor:

Telephone:

Reason for Leaving/Wanting to Leave:

Employer:

Date:

From:

To:

Work Performed:

Hourly Rate/Salary:

Starting:

Final:

Address:

City:

State:

Zip:

Telephone:

Supervisor:

Telephone:

Reason for Leaving/Wanting to Leave:

Employer:

Date:

From:

To:

Work Performed:

Hourly Rate/Salary:

Starting:

Final:

Address:

City:

State:

Zip:

Telephone:

Supervisor:

Telephone:

Reason for Leaving/Wanting to Leave:

*Are you currently employed?	Yes No
*May we contact your present employer?	Yes No
*May we contact your previous employers?	Yes No
If No, please identify any exceptions and reasons for not contacting prior employers:
*Have you ever been dismissed or forced to resign from any employment?	Yes No
If yes, please explain:

MILITARY DATA
Have you ever served in the U.S. Armed Forces?	Yes No
If yes, beginning and ending date of active duty:	From:	To:
Describe any military training received relevant to the position for which you are applying:

REFERENCES*
Name:	Address:	Phone #:	(Select one) Professional Personal
			(Select one) Professional Personal

Name:	Address:	Phone #:	(Select one) Professional Personal
			(Select one) Professional Personal

Name:	Address:	Phone #:	(Select one) Professional Personal
			(Select one) Professional Personal
May be professional or personal – NO relatives* and ALL information requested must be completed.
*Can you operate a Personal Computer?		Yes No
If yes, please indicate software you can utilize:
*** If you are applying for a driving position please answer the following:
What type of license do you possess?
What endorsements do you have?
What certifications do you have?
Do you currently have a child in the Head Start Program?		Yes No
If yes, at what center?
Have you ever volunteered at a Head Start Center?		Yes No
Which Center?
What did you do?
When?
How long?	(yrs)	(mos)

PLEASE READ BEFORE SUBMITING APPLICATION

1.I certify that my answers to the questions contained in this application and related re-employment or employment documents are complete, true, and correct to the best of my knowledge and belief. I understand I am required to provide the Columbus Urban League (CUL) with complete and correct information regarding my former employers. If the above information is not provided, I will not be considered for employment.

2.I give CUL permission to communicate with all or any of my previous employers for references. I authorize all past employers, educators, and the references listed on my application form, to give CUL any, and all, information concerning previous employment, education, qualifications, and any pertinent information, personal or otherwise, and release all parties from any liability which may result from furnishing this information to CUL. 

3.If hired, I agree to comply with all policies, rules and regulations shown in manuals, instructions and other communications to employees.

4.I understand that, if hired, I would be free to leave CUL employment at any time, within policy guidelines, and for any reason. I also understand that my employment with CUL can be terminated at any time, with or without cause, by CUL. I further understand that this application is not an offer or employment contract for a definite term or duration.

5.I understand that all applicants who have been given a conditional offer of employment must submit to a drug test, and that if I refuse to take a test or my test results are positive, that I will be denied employment. CUL is a Drug-Fee Workplace and has an "Employee Conduct" policy (including substance abuse) for its employees.

6.I acknowledge, if I am hired by CUL, that I will not be permitted to smoke within a CUL facility.

7.I understand that I will be required to submit to a drug screening for any on-the-job injury or accident that occurs.

I Agree I Disagree

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