Employment Application - CASA of Southern Kentucky

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References Why your

Personal Information

Please fill out all the sections below:

Today's Date *

Name *

First

Middle

Last

Maiden or Other Name

Email Address *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Tentative Start Date *

Salary Required *

Are You Employed Now? *

May We Contact Your Present Employer *

Referred By *

How Did You Hear About This Position? *

Education and Training

High School/GED Name and Location *

Year of Graduation *

Area of Study/Degree *

College Name and Location *

Year of College Graduation

Area of Study/Degree *

Employment History

Employment Dates *

Name & Location *

Position & Responsibilities *

Reason For Leaving *

Employment Dates *

Name & Location *

Position & Responsibilities *

Reason For Leaving *

Employment Dates

Name & Location

Position & Responsibilities

Reason For Leaving

I give permission for CASA SKY to contact the above listed employer(s) as a reference: *

Additional Personal Information

Are you a U. S. citizen or approved to work in the United States? *

What documentation can you provide as proof of citizenship or legal status? *

Have you ever been convicted of a criminal offense (felony or misdemeanor)? *

If yes, please state the nature of the crime(s), when and where convicted and disposition of the case:

Job Skills/Qualifications

Please list below the skills and qualifications you possess for the position for which you are applying: *

Information Relating to Experience

What type of licenses or certifications do you hold that would assist in your performance on this job?

What is your experience working with children? Please include both paid and volunteer experience such as child welfare, foster care, adoption, mentoring, teaching, etc. *

What is your experience with volunteer management, fundraising and/or grant writing? Please explain your successes.

Why are you interested in a position with CASA of Southern Kentucky?

References

Name *

Phone

Years Aquainted *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Name *

Phone

Years Aquainted *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Name *

Phone

Years Aquainted *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Background Check Requirements

My signature below authorizes the Kentucky CASA Network and/or CASA of Southern Kentucky to make necessary background checks to determine suitability of employment. This may include but is not limited to child abuse and neglect records, criminal records, sex offender registries and any other individuals or agencies that may have knowledge of applicant. These checks will be conducted prior to employment and periodically for the duration of employment.

Date *

Signature

Clear Signature

List of Previous Residences

Please list ALL complete addresses of residence during the last seven years.

Previous Address

Address Line 1

Address Line 2

City

State

Zip Code

Previous Address

Address Line 1

Address Line 2

City

State

Zip Code

Previous Address

Address Line 1

Address Line 2

City

State

Zip Code

Previous Address

Address Line 1

Address Line 2

City

State

Zip Code

At-Will Employment

The relationship between you and the CASA of Southern Kentucky is referred to as “employment at will.” This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or CASA of Southern Kentucky. No representative of the CASA of Southern Kentucky has authority to enter into any agreement contrary to the foregoing “employment at will” relationship. You understand that your employment is “at-will” and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and our CASAof Southern Kentucky Chairperson who shall be a representative of the Board of Directors.

I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE.
AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS OR MISREPRESENTATIONS ARE
DISCOVERED, MY APPLICATION MAY BE REJECTED AND IF I AM EMPLOYED, MY EMPLOYMENT MAY BE
TERMINATED AT ANY TIME.

Date *

Signature *

Clear Signature