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Crossroads Community Inc.

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Crossroads Community, Inc. Job Application

Complete and submit the form below, or click on the link below to print an application form.

Your Personal Information
Name:
Address:
City, State, ZIP:
Phone Number:
Cell Phone:
Email Address:
Position for which you are applying:
 
Education
High School Graduate?:
Yes
No
College Graduate?:
Yes
No
Educational Information: Give Name & Location of High School and College, highest degree or diploma earned and area of study:
 
Legal Status/Information
Are You Legally Able to Work in the U.S.?:
 
Yes
No
Do you currently have a valid Drivers' License?:
 
Yes
No
Have you had more than 4 points on your Driving Record in the past 36 months?:
 
Yes
No
Driving Experience: Have you ever driven a 15-passenger van?:
 
Yes
No
Liability Insurance: Crossroads requires employees to drive their own vehicles when needed & requires the employee to carry liability insurance of at least 100/300/50 on their vehicle. If employed, do you agree to comply with this requirement as a condition of employment?:
 
Yes
No
Have you been convicted of a DWI, DUI or any other criminal act at any time in the last 5 years?:
 
Yes
No
Fitness for Duty/Certifications
If you have any physical or mental conditions that might be a factor in performing any work in the position for which you are applying, please explain:
 
Are you currently certified in CPR?:
 
Yes
No
Are you currently certified in First Aid?:
 
Yes
No
Experience
Work History: List Most Recent Employer First. Include length of time in each position (mo/yr - mo/yr), employer name, address, phone, supervisor, position held and reason for leaving for each position:
 
References
List at least 3 professional references. Include name, address, phone number, the reference's occupation, and length of time known:
 
May we contact your current employer for a reference at this time?:
 
Yes
No
By submitting this application on-line, I give permission for Crossroads Community, Inc. to contact any or all references listed. I understand that CCI will need to contact my current employer for a reference if/when making a job offer:
 
Yes
No
Affirmation
Acknowledgment of CCI Employment Practices: I understand & agree that if employed, my employment is for no definite period & may, regardless of date of payment of wages, be terminated at any time without previous notice:
 
Yes
No
Assertion of Accuracy: By submitting this application on-line, I assert that it contains accurate information. I authorize the investigation of all statements contained herein. I understand that misrepresentation or omission of facts is cause for dismissal.:
 
Yes
No