Employment Application

Please use the following form to apply:

"*" indicates required fields

Step 1 of 9

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Personal Information

Position for which you are applying:*

Date available to start:*

Expected salary or hourly rate:*

First Name*

Middle Name

Last Name*

If you have used other names used in school or employment, please list them:

Address*

Street Address Address Line 2 City State ZIP Code

Phone Number*

Email Address*

Are you over 18 years of age?*

Yes

Are you authorized to work in the United States?*

Yes

Have you ever applied for work with Family Futures?*

Yes

If yes, when did you apply?*

Skills and Qualifications

Please select from the common skills below and rate your experience level:

Skill Type

Word Processing

Spreadsheet

Database

Fund Development

CMS (Content Management Software)

Accounting

Social Media

Word Processing Experience

List software your have experience with and your experience level with them:*

Spreadsheet Experience

List software your have experience with and your experience level with them:*

Database Experience

List software your have experience with and your experience level with them:*

Fund Development Experience

List software your have experience with and your experience level with them:*

CMS (Client Management Software) Experience

List software your have experience with and your experience level with them:*

Accounting Experience

List software your have experience with and your experience level with them:*

Social Media Experience

List software your have experience with and your experience level with them:*

Additional Skills / Experience

Please list any other skills, qualifications, or experiences you have that you feel would be an asset to Family Futures:

Physical Limitations

This position requires lifting up to twenty pounds and using your personal vehicle for deliveries or attendance of meetings (mileage is reimbursable). Are you able to do the job for which you are applying?

Yes

If no, please explain:

Do you have a valid driver’s license?

Yes

Can you perform the essential functions of the position with or without accommodations?

Yes

If no, please explain:

Will you require any accommodations to participate in the application process and/or job interview, including testing (which may be required to determine your qualifications for the position)?

Yes

If yes, please explain:

Military Record

(Service in U.S. Armed Forces or State Militia only) if applicable:

Have you ever served in the United States Military?*

Yes

Military Record Details

If you answered yes, please provide additional details about your military service:

Branch of Service

Start of Service Date

End of Service Date

Rank on discharge or present rank:

Military occupational specialty:

Honorable Discharge?

Yes

Criminal History

A felony conviction will not automatically preclude an applicant from a job offer.

Have you ever been convicted of a crime or are you presently charged with a felony?*

Yes

If you answered yes, where and when and explain the circumstances:*

Have you ever been convicted of child abuse or neglect?*

Yes

If you answered yes, where and when and explain the circumstances:*

Education

Please select all education levels you have completed:*

High School

College or University

Graduate School

Specialized Training

Other

If you chose 'Other', please explain:*

High School Details

Name and Location of School*

Years Attended*

Graduation Date*

GPA*

College or University Details

Name and Location of School*

Years Attended*

Graduation Date*

Major*

Diploma or Degree*

GPA*

Graduate School Details

Name and Location of School*

Years Attended*

Graduation Date*

Major*

Diploma or Degree*

GPA*

Specialized Training Details

Name and Location of School*

Years Attended

Graduation Date

Major

Diploma, Degree, or Certification*

GPA

Related Course Work

Please list any completed course work relating to childhood development or parenting:

Professional References

Please list three professional references that have personal knowledge of your work experience.

Reference 1

Name*

Relationship*

Phone*

Employer*

Position*

Reference 2

Name*

Relationship*

Phone*

Employer*

Position*

Reference 3

Name*

Relationship*

Phone*

Employer*

Position*

Employment History

List all employment (starting with your most recent). Please fill out the information on this form. If you have no prior employment history, you may skip this section.

If you have no employment history, please check the box so you may skip this section.

I have no employment history.

Employment 1

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 2

Add Another Employer

Employment 2

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 3

Add Another Employer

Employment 3

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 4

Add Another Employer

Employment 4

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 5

Add Another Employer

Employment 5

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 6

Add Another Employer

Employment 6

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 7

Add Another Employer

Employment 7

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 8

Add Another Employer

Employment 8

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 9

Add Another Employer

Employment 9

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 10

Add Another Employer

Employment 10

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 11

Add Another Employer

Employment 11

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 12

Add Another Employer

Employment 12

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 13

Add Another Employer

Employment 13

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 14

Add Another Employer

Employment 14

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 15

Add Another Employer

Employment 15

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 16

Add Another Employer

Employment 16

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 17

Add Another Employer

Employment 17

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 18

Add Another Employer

Employment 18

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 19

Add Another Employer

Employment 19

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 20

Add Another Employer

Employment 20

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 21

Add Another Employer

Employment 21

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 22

Add Another Employer

Employment 22

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 23

Add Another Employer

Employment 23

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 24

Add Another Employer

Employment 24

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 25

Add Another Employer

Employment 25

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 26

Add Another Employer

Employment 26

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 27

Add Another Employer

Employment 27

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 28

Add Another Employer

Employment 28

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 29

Add Another Employer

Employment 29

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Add Employer 30

Add Another Employer

Employment 30

Employer*

Date Employed From:*

Date Employed To:*

Supervisor's Name:

Supervisor's Phone:

Starting Pay ($):

Ending Pay ($):

Reason For Leaving:*

Please explain your position, title, and duties:*

Authorization and Signature

Please read the following statements carefully before signing to indicate your understanding and agreement:

Certificate of Truthfulness*

I certify that all statements on this Application for Employment are made truthfully and without evasion, and further understand and agree that such statements may be investigated and if found to be false will be sufficient reason for not being employed, or if employed may result in my dismissal.

Authorization for Employment/Educational Information*

I authorize the references listed in the Application for Employment, and any prior employer, educational institution, or any organizations to give Family Futures any and all information concerning my previous employment/educational accomplishments, disciplinary information or any other pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I hereby waive written notice that employment information is being provided by any person or organization.

Authorization to Work*

If I am selected for hire, I will be offered employment provided that I am authorized to work as requested by the Immigration Reform and Control Act of 1986.

Employment at Will*

If I am hired, in consideration of my employment, I agree to abide by the rule and policies of Family Futures, including any change from time to time, and agree that my employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of either Family Futures or myself. I understand that no manager or other representative of Family Futures, other than the Executive Director has any authority to enter into any agreement for employment for any specific or indefinite period of time, or to make any agreement contrary to the foregoing. Any such agreement made by the Executive Director must be made in writing to be effective.

Limitation on Claims*

I agree that any action or suit against Family Futures arising out of my employment or termination of employment, including but not limited to claims arising under State or Federal civil rights status, must be brought within 180 days of the event giving rise to the claim or be forever barred. I waive any statute of limitations to the contrary.

Need for Accommodation*

If I have a disability and know that I need an accommodation to perform the job, I must notify Family Futures of that need within 182 days. Failure to do so will bar me from alleging that Family Futures has not accommodated me as required by law. I understand that if I have a protected disability that affects my ability to do the job I seek, I may ask Family Futures to attempt to make a reasonable accommodation for it. I must make the request in writing to the Executive Director as soon as possible after the date I know the accommodation is needed.

Signature*

Your Name
Your Name
Your Name

Date

Consent for Signature

I consent to the collection of my electronic signature.

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