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Employment Application
SEK-CAP
>
Employment Application
.
Employment Application
Step
1
of
7
14%
Hidden
Job Title
Hidden
Job Number
Position Title
(Required)
First Name
(Required)
Middle Name
Last Name
(Required)
Address
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Your Email Address
(Required)
Phone Number
(Required)
How did you learn about this position?
(Required)
--
Advertisement
Indeed
Kansas Works
Job Fair
Newspaper
Radio
Social Media
Friend or Referral
SEK-CAP Website
Other
What is the name of the employee?
(Required)
Specify where you learned of this position.
(Required)
Are you legally eligible to work in the US?
(Required)
--
Yes
No
Will you now or in the future require sponsorship for employment visa status (eg H-1B visa status)?
(Required)
Note: The Federal Immigration and Reform and Control Act of 1986 requires that a DHS Employment Eligibility Verification "Form I-9" be completed for every new hire and that within 3 business days of beginning work every new hire must present to the employer documentation establishing his/her identity and authorization to work. The federal requirements must be satisfied as a condition of employment.
--
Yes
No
Are you at least 18 years of age?
(Required)
--
Yes
No
Are you a current or former Head Start/Early Start Parent?
(Required)
--
Yes
No
Are you a current or former Head Start/Early Start Child?
(Required)
--
Yes
No
Do you have a resume to upload?
--
Yes
No
Upload Your Resume
(Required)
Upload your resume in .pdf, .doc or .docx format
Accepted file types: pdf, doc, docx, Max. file size: 25 MB.
Upload College Transcript
If you have an Associates degree or higher, transcripts must be attached for consideration.
Accepted file types: pdf, doc, Max. file size: 50 MB.
Employment History
Most Recent Employer
Supervisor Name
Email Address
Phone
Your Position Title
Describe Your Job Duties
Starting Pay
Ending Pay
Reason for Leaving
Is this your current employer?
(Required)
--
Yes
No
May we contact for reference?
(Required)
--
Yes
No
Employment Start Date
(Required)
MM slash DD slash YYYY
Employment End Date
(Required)
MM slash DD slash YYYY
Do you have another job you'd like to enter?
(Required)
--
Yes
No
Employment History
Employer #2
Email Address
Phone
Your Position Title
Supervisor Name
Describe Your Job Duties
Starting Pay
Ending Pay
Is this your current employer?
(Required)
--
Yes
No
May we contact for reference?
(Required)
--
Yes
No
Employment Start Date
(Required)
MM slash DD slash YYYY
Employment End Date
(Required)
MM slash DD slash YYYY
Do you have another job you'd like to enter?
(Required)
--
Yes
No
Employment History
Employer #3
Your Position Title
Supervisor Name
Describe Your Job Duties
Email Address
Phone
Starting Pay
Ending Pay
Is this your current employer?
(Required)
--
Yes
No
May we contact for reference?
(Required)
--
Yes
No
Employment Start Date
(Required)
MM slash DD slash YYYY
Employment End Date
(Required)
MM slash DD slash YYYY
Education History
School Name
(Required)
School Address
(Required)
Phone Number
(Required)
Degree/Program
(Required)
Enrollment / Graduation Status
(Required)
--
Currently Enrolled / In-Progress
Received Degree
Degree Incomplete
References
Please include 3 personal or professional references
Reference #1 Name
(Required)
Phone
(Required)
Email
(Required)
What is your relationship to the reference and how long have you known them?
(Required)
Reference #2 Name
(Required)
Phone
(Required)
Email
(Required)
What is your relationship to the reference and how long have you known them?
(Required)
Reference #3 Name
(Required)
Phone
(Required)
Email
(Required)
What is your relationship to the reference and how long have you known them?
(Required)
Professional Licenses & Certifications
Please list your credentials and/or licenses
Include credential/license type, number (if applicable), issuing agency, standing and expiration date for each
Application agreement
Qualification Evaluation
(Required)
I understand that this application form was intended for use in evaluating my qualifications for employment and that this application is not an offer of employment. I further understand that if hired, my employment will be considered "at-will" and that my employment may be terminated for an reason, with or without cause or notice, at any time by me or the Company and that this application is not intended to constitute a contract of continued employment.
I agree
Statement Truthfulness
(Required)
I certify that the information submitted by me on this application is true and complete. I understand that any false information, misrepresentation or omissions on this application, resume or on other written materials, provided during any interviews will lead to the rejection of my application or, if I am employed, discipline up to and including termination at the time such false information or omission is discovered.
I agree
Drug Testing and Medical Review
(Required)
I understand that additional testing of job-related skills and for the presence of drugs may be required prior to employment. I also understand that after an offer of employment and prior to reporting to work, I may be required to submit to a medical review and depending on Company policy and the needs of the job, I may be required to complete a medical history form and be examined by a medical professional designated by the company. I also understand that I may not be under the influence of drugs or alcohol during employment and that if Company policy so requires, I may be required to submit a drug and/or alcohol testing at an approved testing facility.
I agree
Smoking Prohibited
(Required)
I understand that smoking is prohibited in all indoor areas of the Company's facility unless designated smoking areas have been established at a particular location in accordance with applicable state and local law.
I agree
Information Verification
(Required)
I authorize the Company and.or its agents, including consumer reporting agencies, to investigate and verify any of the information provided by me. I authorize my former employers, educational institutions, references and any relevant agencies to provide information to the Company and/or its agents concerning my background and experience. I release the Company and all parties providing information to the Company about my background and experience from any liability what so ever arising therefrom.
I agree
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