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EMPOYMENT APPLICATION

*WE ARE AN EQUAL OPPORTUNITY EMPLOYER*

Date How Did You Hear of This Job?

Name

Phone Number

EMPLOYMENT AVILABILITY

Date available to begin work: Full Time (30-40 hr): Part Time (under 30 hr):

List hours you are available to work (please specify by day):

EMPLOYMENT HISTORY
*List your employment record in chronological order, beginning with your current or most recent employer.

Company Name

Company Address

Date of employment:

Salary

Supervisor Name

Supervisor Contact Number

Job Title

Reason for Leaving

Duties and Responsibilities

Company Name

Company Address

Date of employment:

Salary

Supervisor Name

Supervisor Contact Number

Job Title

Reason for Leaving

Duties and Responsibilities

Company Name

Company Address

Date of employment:

Salary

Supervisor Name

Supervisor Contact Number

Job Title

Reason for Leaving

Duties and Responsibilities

EDUCATION

School

City, State

Date Attended

Degree(s) Earned / Area of Study

CAREGIVER TRAINING

Type of Training

Date Attended

Date of Expiration if applicable

Type of Training

Date Attended

Date of Expiration if applicable

Type of Training

Date Attended

Date of Expiration if applicable

PLEASE PROVIDE 3 PERSONAL REFERENCES

Name

Relationship

Phone Number

Are they a current Cooperative Member

Name

Relationship

Phone Number

Are they a current Cooperative Member

Name

Relationship

Phone Number

Are they a current Cooperative Member

GENERAL

Why do you want to work at Cardinal Comfort Care Cooperative and what attracts you to a caregiver position?

Please tell us about your experience with cooperative groups and/or your thoughts about working as an owner within a cooperative business?

Is there anything else you'd like to add about yourself?

Acceptance

I certify that the information contained in the application is true and correct to the best of my knowledge. I authorize the references,schools and previous employers listed to provide CCCC any and all information they may have. I release all parties and persons listed, or any of its members or employees from all liability for any damage, except that resulting from misrepresentation which might result from furnishing this information. I further understand that employment is on an “at will” basis and employment is not guaranteed for any term, and may be terminated by the co-op or myself for any reason at any time, with or without notice.

Signature

Date

Employment

EMPOYMENT APPLICATION

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