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Application for Employment

Applicant Data
First Name *
Middle
Last Name *
Suffix
Other names by which you are known?
Country
Address Line 1 *
Address Line 2
City *
State/Province *
Postal Code *
When can you begin work?
Position for which applying?
Location of position?
Minimum acceptable salary?
Willing to travel?
Are you willing to travel if job requires?
Willing to work flexible hours?
Are you willing to work flexible hours to accommodate clients?
How were you referred to us?

Health

Need Reasonable Accommodations?
Are any accommodations needed in order for you to perform the job functions?
If yes, please describe:
Willing to take TB Test
CAS Staff are required to have a physical with TB skin test prior to employment and bi-annually thereafter. Are you in agreement with this policy?

Who should we notify in case of an emergency?

Emergency Contact Name
First Name *
Last Name *
Suffix
Emergency Contact Phone:

Education

High School Name & Location (City, State)
Degree or Diploma?
Did you graduate?
Did you graduate?

U.S. Military Service

Are you a veteran?
Are you a veteran? If yes, be sure to include in work history on next page.

Licenses and Special Skills

List any professional or occupational licenses that you hold ( if applicable, include license number and current status):
Other Accreditation?
List any languages that you speak in addition to English:
Describe your computer skills:
Alabama Driver's License?
Do you possess a valid Alabama Driver's License?
Automobile insurance?
Do you have automobile insurance?
*Agency Requirement 100/300 minimum*

Please attach additional Work History/ Resume.
No file selected
Professional References
Reference Name & Email Address
Reference Name & Email Address
Reference Name & Email Address


STATEMENT OF POLICY 
Children’s Aid Society of Alabama (CAS) is an Equal Opportunity Employer.  Federal law prohibits discrimination in employment practices because of race, color, religion, sex, age, national origin, disability or veteran status.  No question on this application is asked for the purpose of limiting or excluding any applicant’s consideration for employment because of his or her race, color, religion, sex, age, national origin, or due to disability or veteran status. 
PREEMPLOYMENT STATEMENT 
I understand and agree that: 
1. The information that I have provided on this application is true and complete to the best of my knowledge.  Any misrepresentation or omission of any fact in my application, resume, or any other material, or during any interviews, can be justification of refusal of employment, or, if employed, termination from CAS employment. 
2. Any offer of employment I may receive from CAS is contingent upon my successful completion of the agency’s total pre-employment screening process, including the agency’s receiving references that it considers satisfactory, and my satisfactory completion of any post-offer pre-employment medical examination that the agency may require.  I also agree, if employed, to submit to a medical examination at any time at the agency’s request.  I hereby consent to having the results of any post-offer pre-employment or post-employment medical exams I may be required to take disclosed to CAS. 
3. As a condition of employment, I may be required to undergo and successfully pass any tests required of my position including but not limited to a screening for alcohol and/or drugs, criminal background, and motor vehicle records.  I also understand and agree that, if employed, I may be required to submit to an alcohol or drug screening at any time at the discretion of CAS.  I hereby consent to having the results of any such alcohol or drug screening I may be required to undergo disclosed to CAS. CAS reserves the right to terminate the employment relationship at any time if I fail to complete any of the steps or if any of the steps indicate positive results.  CAS assumes no responsibility for placing me in another position if I were to be terminated.  
4. In processing my application for employment, the agency may verify all the information provided by me, or may procure or have prepared a consumer or an investigative consumer report for this purpose concerning my prior employment, military record, education, character, general reputation, personal characteristics, criminal record, and credit history.  I understand that upon written request to the agency, I will be informed whether an investigative consumer report was requested and given full information as to the nature and scope of this investigation. 
5. I authorize and request that all of my present and former employers and those individuals I have listed as personal references furnish information about my employment record, including a statement of the reason for the termination of my employment, work performance, abilities, and other qualities pertinent to my qualifications for employment, hereby releasing them from any and all liability for damages arising from furnishing the requested information. 
6. I should promptly report any job-related harassment, related complaints, or if I believe that I have been treated in an unlawful discriminatory manner to my supervisor or the Vice President of Human Resources of CAS by calling (205) 251-7148.  I also understand that I should report any concerns about policies, procedures, practices, or any issue arising in the workplace to my immediate supervisor, where practicable, or the Vice President of Human Resources. 
7. In consideration of my employment, I agree to comply with the policies, rules, regulations, and procedures of CAS, including but not limited to CAS’ drug and alcohol policy, sexual harassment policy, and conflict resolution policy, and understand that my employment and compensation can be terminated with or without cause or notice, at any time, at the option of either the agency or myself.  I further understand that no supervisor or representative of the agency, other than the Chief Executive Officer, has any authority to enter into any agreement with me for employment for any specified period of time or to make any agreement different from or contrary to the foregoing.  I further understand that any such agreement, if made, shall not be enforceable unless it is in writing and signed by me and by the Chief Executive Officer of CAS. 

By clicking submit, I am stating that I understand the CAS Pre-Employment Policy and that all information submitted is true and accurate.
First Name *
Last Name *

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