APPLICATION FOR EMPLOYMENT

Council on Aging of Volusia County 160 North Beach Street Daytona Beach, FL 32114

Council on Aging of Volusia County Inc. is an equal opportunity employer by both policy and practice and complies with all Federal and State laws which forbid discrimination. Complete all sections which pertain to you. Do not include a resume as a substitute for completing the application. Sign and date the application. Applications with missing information will not be considered applications under the law. First, how did you hear about this position? Position applied for: TELEPHONE: (____) Date: _____ __ _

CELL PHONE (____)______________________ E-MAIL: (PRINT) LAST NAME:
ADDRESS

__
MI

(PRINT) FIRST NAME
CITY STATE

ZIP

FL
Are you eligible to work in the USA? Yes NO Yes No If you are under the age 18, can you provide proof of eligibility for work? Have you, since the age of 18 been convicted of a felony? Yes No

If yes, please explain (A conviction will not necessarily exclude you from employment. Each conviction will be judged on its own merit with respect to the time, circumstances and seriousness). Have you ever applied to us before? Yes No If yes, give date If employed, may we contact your present employer? Yes No Are you available to work: Full Time Part Time Nights Weekends

EDUCATION
Name of School High School Undergraduate Graduate Other Course of Study
Years Completed

Degree

SKILLS
List any business machines you are capable of operating and any other special skills relevant to the position for which you are applying. Please ( ) all that applies:

Word processor/Computer: Microsoft Word ___ Excel ___ Outlook ___ WordPerfect ___Lotus 1-2-3 ___ Multi-line Phone System ___ Copier ___ FAX ___ World Wide Web-Internet ___ Other___

List any other hobbies, interests or other skills which have a direct bearing on the job you are seeking. List any language, other than English, you can speak. You are not required to list any information which might reveal your race, religion, sex or national origin.

EMPLOYMENT HISTORY
Complete your job history for the last four employers or a minimum of ten years. Fill in all contact phone numbers and addresses for prior & current employers.
Company Name Address City/State/Zip Supervisor From To Company Name Address City/State/Zip Supervisor From To Company Name Address City/State/Zip Supervisor From To Company Name Address City/State/Zip Supervisor From To Job Title Work Performed Reason For Leaving Job Title Work Performed Reason For Leaving Job Title Work Performed Reason For Leaving Job Title Work Performed Reason For Leaving Phone: Salary

Phone: Salary

Phone: Salary

Phone: Salary

REFERENCES
1. 2. 3. Name Name Name Phone # ( Phone # ( Phone # ( ) ) )

COUNCIL ON AGING CONSENT AGREEMENT
Reference Checking and Background Investigations: I hereby give the Council on Aging the right to make a thorough investigation of my past employment, education, activities and credit history. In addition, upon employment, I agree to submit to a security examination at any time at the request and expense of the Council on Aging as permitted by law. I understand that the results of any such investigation may be used to make decisions concerning my employment. I release and indemnify the Council on Aging against any liability which might result from making such an investigation. I UNDERSTAND THAT ANY FALSE ANSWER OR STATEMENTS OR IMPLICATIONS MADE BY ME IN THIS APPLICATION OR OTHER REQUIRED DOCUMENTS, MAY RESULT IN DENIAL OF EMPLOYMENT OR SUBSEQUENT DISCHARGE. I further understand and agree that the results of any investigation may be communicated to the Council on Aging, and any others it deems appropriate. Employment at Will I understand that my employment status is "at will" and, that the Council on Aging reserves the right to terminate my services at any time, with or without notice, with or without cause. Furthermore, I understand that