Canvas Program Employment Application

This Organization Is An Equal Opportunity Employer

Today's Date
Name
Soc. Sec. #

Current Address
Address
Phone

Permanent Address
Address
Phone

Email Address

About This Job

How did you learn about this job?

What are the most important factors in choosing your job?
Scale from 1 to 5 (5 being least important)
Career opportunities   
Work environment
Working for what you believe in
Salary
Other

Education History
High School   Major   Year Grad.
College   Major   Year Grad.
Post Grad./ Other Major   Year Grad.

Employment History
Employer     Position
Address
Period Employed Reason Left
Employer Position
Address
Period Employed Reason Left

Professional References (Other Than Friends and Relatives)
Name   Position
Organization    Phone
Address

Volunteer Experience (Political or Community)
 

What are your plans for the future?
 

Health Information

THE JOB YOU ARE APPLYING FOR INVOLVES A SUBSTANTIAL AMOUNT OF PUBLIC CONTACT AND PRESENTATION OF POLITICAL ISSUES. DO YOU HAVE ANY HEALTH CONDITIONS, REQUIREMENTS, OR PHYSICAL HANDICAPS THAT COULD IMPACT YOUR PERFORMANCE?
 

Criminal Record
Have you ever been convicted of a crime? No     Yes – please specify below
 

In Case of an Emergency
Notify Phone
Relationship

I CERTIFY THE TRUTH AND ACCURACY OF ALL THE INFORMATION CONTAINED IN THIS APPLICATION, ANY ATTACHMENTS TO THIS APPLICATION, AND ANY RESUME I HAVE SUBMITTED. I UNDERSTAND THAT PROVIDING FALSE INFORMATION IN CONNECTION WITH THIS APPLICATION IS GROUND FOR DISCHARGE IF I AM HIRED.
I Agree I Disagree
If you have any questions, please contact Canvass Director, Kim Drone — kim@njcitizenaction.org.

  

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