Delmarva Community Services, Inc.
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Title VI information
united way of the lower eastern shore
Chesapeake Grove
Employment Application Online Form
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Indicates required field
Name
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First
Last
Personal Information
Email Address
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We don't share this information!
Gender
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Male
Female
Address
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Line 1
Line 2
City
State
Zip Code
Country
Phone Number
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Social Security Number
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Do not use hyphens
Are you over the age of 21?
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Yes
No
Are you legally eligible for employment in the U.S.A?
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Yes
No
Position Applying for:
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Driver
Residential Care
Habilitation Day
Medical Adult Care
Administration
Other
If your application is considered favourably, on what date will you be available for work?
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Were you previously employed by us?
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Yes
No
If yes, when or what year?
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Are there any other job - related experiences, skills or qualifications?
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Employment History
In this section, list present and past employment, beginning with most recent. Please complete information for up to 4 employers.
Upload Resume
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Max file size: 20MB
If you have a resume prepared, please upload here
I hearby give permission to contact the following employers concerning my prior work experience:
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Employer 1
Employer 2
Employer 3
Employer 4
Employer 1
Employer 1 - Name
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Employer 1 - Phone
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Employer 1 - From Month/Year to Month/Year:
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(i.e., Jan. 1, 2002 to Feb. 12, 2012)
Employer 1 - Weekly starting salary
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Employer 1 - Weekly ending salary
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Employer 1 - Reason for leaving:
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Employer 1 - Name of Supervisor
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Employer 1 - Describe the work you performed:
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Employer 2
Employer 2 - Name
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Employer 2 - Phone
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Employer 2 - From Month/Year to Month/Year
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Employer 2 - Weekly Starting Salary
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Employer 2 - Weekly ending salary
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Employer 2 - Reason for leaving
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Employer 2 - Name of Supervisor
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Employer 2 - Describe the work you performed:
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Record of Education
Name and Address of Elementary School:
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Indicate last year completed:
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5
6
7
8
Did you graduate?
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Yes
No
Name and Address of High School?
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Course of Study
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Indicate last year completed:
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9
10
11
12
Did you Graduate?
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No
Yes
Diploma or Degree:
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Name and Address of College:
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Course of Study
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Did you Graduate?
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Yes
No
Not Yet
Indicate Graduation year or anticipated graduation year:
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Diploma or Degree:
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Name and Address of Other Education:
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Course of Study
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Did you Graduate?
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Yes
No
Not Yet
Indicate graduation year or anticipated graduation year:
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Diploma or Degree:
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Personal References
Name and Occupation:
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Phone Number
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Name and Occupation:
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Phone Number
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Name and Occupation
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Phone Number
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Permission and Agreement
May we telephone you at home to follow up on this application?
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Yes
No
When is the best time to contact you?
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Morning
Afternoon
May we telephone you at work to follow up on this application?
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Yes
No
When is the best time to contact you?
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Morning
Afternoon
I agree to the terms and conditions listed at the right of this page:
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Yes
By submitting details in above form you're agree to following terms:
1.
Under Maryland law, an employer may not require or demand any applicant for employment or prospective employment or any employee to submit to or take a polygraph, lie detector or similar test or examination a condition of employment or continued employment. Any employer who violates this provision is guilty of a misdemeanor and subject to a fine not to exceed $100.
2.
The facts set forth in my application for employment are true and complete. I understand that if employed, any false statement on this application may result in my dismissal. I further understand that this application is not and is not intended to be a contract of employment, not does this application obligate the employer in any way if the employer decides to employ me. I understand and agree that my employment is at will and can be terminated by either party with or without notice, at any time, for any reason or no reason. No one other than an officer of the Company has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing and then only in a writing signed by an officer.
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