CMHS Employment Application

EMPLOYMENT HISTORY

All sections must be completed even if it mirrors your resume.

Most recent or current employer:

Position Title:

Address:

City:

State:

ZIP:

Supervisor:

Phone:

Starging Salary:

Ending Salary:

Dates of employment (Beginning - End):

Reason for Leaving:

Description of Duties, Skills, Accomplishments:

Next recent or current employer:

Position Title:

Address:

City:

State:

ZIP:

Supervisor:

Phone:

Starging Salary:

Ending Salary:

Dates of employment (Beginning - End):

Reason for Leaving:

Description of Duties, Skills, Accomplishments:

Next recent or current employer:

Position Title:

Address:

City:

State:

ZIP:

Supervisor:

Phone:

Starging Salary:

Ending Salary:

Dates of employment (Beginning - End):

Reason for Leaving:

Description of Duties, Skills, Accomplishments:

Next recent or current employer:

Position Title:

Address:

City:

State:

ZIP:

Supervisor:

Phone:

Starging Salary:

Ending Salary:

Dates of employment (Beginning - End):

Reason for Leaving:

Description of Duties, Skills, Accomplishments:

Attach Resume:

Area of Program: Office Classroom Kitchen Maintenance

If applicable, please explain your Head Start experience::

Computer Knowledge:

Indicate the programs you have experience in, indicate length of time, and proficiency level.

Provide Length of Use and Proficiency Level of items checked above:

Please list and describe your computer and technology skills. Provide detailed information on how you have implemented these skills in your previous places of employment:

SKILLS

Please list your relevant knowledge & skills, and briefly explain why you believe you are qualified for this position:

References:

Name:

Address:

Phone:

Business or Personal: Business Personal

Name:

Address:

Phone:

Business or Personal: Business Personal

Name:

Address:

Phone:

Business or Personal: Business Personal

TERMS AND CONDITIONS

I certify that the information contained in this application is correct to the best of my knowledge. I understand that any mis-statement or omission of information may result in denial of employment or discharge. I authorize the employers and references listed above to provide you with any and all information concerning my previous employment, or other pertinent information, personal or otherwise, and hereby release these parties from liability for any damage that may result from furnishing truthful information to you.

I have read and agree to the above terms and conditions:

Thank you for your application. We invite you to voluntarily complete our Affirmative Action Applicant Survey.

WHAT TO EXPECT NEXT:

You should receive a confirmation that we have received your application to the email you provided. Often times, screening and selection takes some time. Applicants that are not selected will be notified by email.

Thank you for your interest!

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