Job Application - STAR Council

Job Applicaton

These instructions must be followed exactly. Fill out application form completely. If questions are not applicable, enter “NA.”
Do not leave questions blank. Be sure to sign when completed. STAR Council is an Equal Opportunity Employer and does not discriminate on the basis of race, color, national origin, sex, religion, age, or disability in employment or the provision of services. You may make copies of this application and enter different position titles, but each copy must be signed. Resumes will not be accepted in lieu of applications. Your completed application will be reviewed carefully, but its receipt
does not imply that you will be employed. Employment considerations necessitate that you meet all minimum qualifications required for the position for which you are applying.

You can also download the form to fill out and fax.

First Name

Last Name

Street Address 1

Street Address 2

City

Zip Code

Phone

Social Security Number

Other Names used during prior employment

List exact title of position or type of work for which you wish to apply

Acceptable salary Range

Do you have any relatives working for STAR Council? If so, list names and relationships

Date available for work?

Are you willing to work hours other than 8-5?

What days are you unable to work?

Are you willing to travel?

If yes, what percent of time?

Are you willing to relocate?

Current Drivers Lic # (if required for position)

Drivers License Class

Commercial Drivers License

How many moving violations during the last 12 months?

Do you currently have Liability Insurance?

Are you at least 18 years of age?

Have you ever been convicted of a felony or subjected to a deferred adjudication on a felony charge?

If your answer is “Yes,” explain in concise detail, giving the dates and nature of the offense(s), the name and location of the court, and the disposition of the case(s). A conviction may not disqualify you, but a false statement will.

(Note: Applicants may be required to provide proof of diploma, degree, transcripts, licenses, certifications, and registrations.)

Are you presently in school?

If yes, give expected completion date

Did you receive a GED?

School 1: Name and Location of School

School 1: Dates Attended

School 1: Date Graduated

School 1: Expected Graduation Date

School 1: Sem/Clock Hours Completed

School 1: Type of Diploma Or Degree

School 1: Major/Minor Fields of Study

School 2: Name and Location of School

School 2: Dates Attended

School 2: Date Graduated

School 2: Expected Graduation Date

School 2: Sem/Clock Hours Completed

School 2: Type of Diploma Or Degree

School 2: Major/Minor Fields of Study

School 3: Name and Location of School

School 3: Dates Attended

School 3: Date Graduated

School 3: Expected Graduation Date

School 3: Sem/Clock Hours Completed

School 3: Type of Diploma Or Degree

School 3: Major/Minor Fields of Study

List the details of any others schools you've attended here

If a license, certificate, or other authorization is required or related to the position for which you are applying, list the certification, date issued, expiration date, issuing authority/location, and license number.

Special Training/Skills/Qualifications: List all job related training or skills you possess and machines or office equipment you can use, such as calculators, printing or graphics equipment, computer equipment, types of software and hardware.

Approximately how many words per minute do you type (if required for this position)?

Sign Language (If required for this position)

Are you a certified interpreter?

Do you speak a language other than English (If required for this position)?

If yes, what language(s) do you speak?

How fluently?

Fair
Good
Excellent

Do you write in a language other than English (If required for this position)?

If yes, which language(s)

Have you ever been employed by STAR Council?

If yes, list dates and position held

Have you ever pleaded guilty to, or been convicted of a criminal offense? (See "Convictions")

If yes, give dates and circumstances

Have you failed to be re-employed, ever been involuntarily discharged, fired or asked to resign a position?

If yes, give dates and circumstances:

Are you a veteran?

If yes, list type of discharge status

Dates of Service (From/To)

Are you a surviving spouse of a veteran?

Are you a surviving orphan of a veteran?

If yes, complete dates of service for veteran (From/To)

This information will be the official record of your employment history and must accurately reflect all significant duties performed. Summaries of experience should clearly describe your qualifications.

Include ALL employment. Begin with your current or last position and work back to your first.
Employment history should include each position held, even those with the same employer.
EMPLOYER ADDRESSES MUST BE COMPLETE MAILING ADDRESSES, INCLUDING ZIP CODE.
Give a brief summary of the technical and, if appropriate, the managerial responsibilities of each position you have held.
For supervisory/managerial positions, indicate the number of employees you supervised.

If you need additional space to adequately describer your employment history, you may attach an employment history providing the same information in the same format as this application form.

Job 1

Position Title

Employer

Mailing Address

Employers Telephone No

Immediate Supervisor Name

Title

Starting and Leaving Dates

Give average # of hours worked per week if part-time

Salary

Summary of experience

What did you like most about this job?

What did you like least about this job?

Specific reason for leaving

Job 2

Position Title

Employer

Mailing Address

Employers Telephone No

Immediate Supervisor Name

Title

Starting and Leaving Dates

Give average # of hours worked per week if part-time

Salary

Summary of experience

What did you like most about this job?

What did you like least about this job?

Specific reason for leaving

Job 3

Position Title

Employer

Mailing Address

Employers Telephone No

Immediate Supervisor Name

Title

Starting and Leaving Dates

Give average # of hours worked per week if part-time

Salary

Summary of experience

What did you like most about this job?

What did you like least about this job?

Specific reason for leaving

Employment History Attachment (if more room is needed)

List four personal references that are not relatives or previous employers

Reference 1

Name

Address

Phone Number

Position or Occupation

How long have you known them?

Reference 2

Name

Address

Phone Number

Position or Occupation

How long have you known them?

Reference 3

Name

Address

Phone Number

Position or Occupation

Reference 4

Name

Address

Phone Number

Position or Occupation

How long have you known them?

List below the names of relatives, friends or acquaintances employed by/or on the Board of Directors of this association and their relationship to you

In the event that you are hired for this position, please indicate the name and licensure/degree you would prefer on your business card, e.g.: John Doe, LMSW, LCDC

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY AND INDICATE YOUR UNDERSTANDING AND ACCEPTANCE

I hereby certify that the information provided on this application is accurate to the best of my knowledge and subject to verification

by STAR Council. I hereby authorize the schools, persons, previous employers, agencies and other organizations named in this application to provide STAR Council and/or its authorized employees, agents or representatives with any relevant information that may be required to arrive at an employment decision and hereby release any such schools, persons, employers, agencies and organizations from any and all liability which they may otherwise incur as a result. I understand that any misrepresentation or omission of a material fact on my application may be justification for refusal of employment.

In the event I am employed, I understand that all employees are subject to termination at the discretion of STAR Council. If in
the event I choose to voluntarily terminate my employment, I am free to do so at any time, and, if I choose to give proper notice of termination, the association may either permit me to continue my employment during the notice period or may accept my resignation immediately.

I understand that, in the event I am employed by STAR Council, my compensation, hours of employment and all other terms and conditions of employment are subject to modification or change by STAR Council at STAR Council's discretion.

I also understand that, if employed, any misrepresentation made by me completing this application shall be considered as sufficient cause for my dismissal without advance notice.

I authorize STAR Council to supply my employment record, in whole or part, in confidence, to any prospective employer, government agency, or other party, with a legal and proper interest.

In the event of my employment, I shall comply with all rules and regulations as set forth in STAR Council's policy manual or other communications distributed to employees, and understand a condition of my employment will be my compliance with STAR Council's controlled substance abuse and testing policy. I have read and support STAR Council's position on the problem of child abuse.

I also understand that my employment is conditional upon my satisfactorily passing a drug screening, if on is requested and until results and until results of my driving record, my criminal history record, reference checks, and other documents required by law are completed, and until information given by me has been verified.

I understand that completion of this form does not guarantee me status as an applicant or any consideration for employment unless I meet all state minimum qualifications required of the position for which I am asking to be considered.

CONVICTIONS: A conviction does not automatically mean you will not be offered a job. What you were convicted of, the circumstances surrounding the conviction and how long ago the conviction occurred are important considerations in determining your eligibility. Give all the facts, so that a fair decision can be made.

I have read the above statement and accept the same as a condition of my employment with STAR Council.

I Agree *

The information requested is being collected for the purpose of reporting to Federal and Equal Employment Opportunity Agencies and will not be considered as part of the application for employment. It will be separate from the application.

First Name

Middle Name

Last Name

Social Security Number

Address

City

Zip Code

Home Phone

Work Phone

Sex

Male
Female

Birth Date

Veteran

Spouse of Veteran

Orphan of Veteran

Specify, if Newspaper or Other

Please review your application and submit

If you are a human and are seeing this field, please leave it blank.