Job Application – UCP Central California

United Cerebral Palsy of Central California Application for Employment

UCP of Central California is an equal opportunity employer

Date

Position(s) Applied for

Referred By

Telephone

Name

First

Last

Is any additional information relative to change of name, use of an assumed name, or nickname necessary to enable a check on your work and education record? If yes please explain.

Address

Street Address

Address Line 2

City

State/Province/Region

Postal/Zip Code

Are you eighteen years of age or older?YesNo

If you are under 18 years of age, can you submit a work permit?YesNo

Can you, after employment, submit verification of your legal right to work in the United States?

YesNo

Have you ever filed an application with us before?YesNo

If yes, give date

Have you ever been employed with UCP before?YesNo

If yes, give date

Do you have any relatives working at UCP?YesNo

If yes, give name(s)

Relationship

Are you currently employed?YesNo

If so, may we contact your present employer?YesNo

On what date would you be available for work?

If applicable to the job applied for:

Do you have a valid driver's license?YesNo

Do you have daily use of a vehicle? YesNo

Education

Elementary School

School Name and Location

Highest Year Completed

High School

School Name and Location

Highest Year Completed

Diploma/Degree/Course of Study

Undergraduate College/University

School Name and Location

Highest Year Completed

Diploma/Degree/Course of Study

Graduate/Professional or Other

School Name and Location

Highest Year Completed

Diploma/Degree/Course of Study

For Clerical Applicants Only

What office machines can you operate?

Computer Software experience

List Program Names

Typing Speed (WPM)

Employment History (List present or last job first)

Employer

Name of Supervisor

Position

Daytime Phone

Address

Street Address

City

State/Province/Region

Postal/Zip Code

Weekly Salary (Last)

Reason for Leaving

Dates Employed

From

Employer

Name of Supervisor

Position

Daytime Phone

Address

Street Address

City

State/Province/Region

Postal/Zip Code

Weekly Salary (Last)

Reason for Leaving

Dates Employed

From

Employer

Name of Supervisor

Position

Daytime Phone

Address

Street Address

City

State/Province/Region

Postal/Zip Code

Weekly Salary (Last)

Reason for Leaving

Dates Employed

From

Employer

Name of Supervisor

Position

Daytime Phone

Address

Street Address

City

State/Province/Region

Postal/Zip Code

Weekly Salary (Last)

Reason for Leaving

Dates Employed

From

Additional Information

Please indicate which foreign language you can read, speak or write, and whether your fluency is fair, good, or excellent.

Describe any specialized training, apprenticeship, skills, or life experiences.

Please list job-related organizations, clubs, professional societies, or other associations to which you belong.

You may omit those which indicate your race, religious creed, color, national origin, ancestry, sex or age.

State any additional information you feel may be helpful to us in considering your application.

References

List below the name, address, telephone of three references not related to you whom you have known at least one year.

Name

Address

Phone Number

Nature of Acquaintance

Second Reference

Name

Address

Phone Number

Nature of Acquaintance

Third Reference

Name

Address

Phone Number

Nature of Acquaintance

I certify that answer given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application unless I have indicated to the contrary.

In the event of my employment, I understand that falsification or omission of any material information on this application, or failure to pass the physical examination, may be considered sufficient cause for immediate termination. I agree that I will abide by all policies and procedures established by the employer.

I hereby acknowledge that my employment is "at will", that I may resign at any time and the employer may terminate my employment at any time, with or without cause, that any assurances of continued employment, whether written, oral or by conduct, shall not be interpreted as changing the nature of the employment relationship.

Signature of Applicant

Date