Job Application Consent Form


Employment Application Consent Form

08/10/2022  9:36:20 AM

I , authorize North Central West Virginia Community Action Association and /or its agents to conduct independent investigation of my background, references, past employment, education, criminal or police records, including those maintained by both public and private organizations and all public records for the purpose of verifying the information contained on my application.


I release North Central West Virginia Community Action Association and/or its agents and any person or organization that provides information related to this authorization from any and all liabilities, claims, or lawsuits in regard to the information obtained from any of the above.


I affirm that all information on this application is correct and complete. I understand that any misstatement of facts will be grounds for the disqualification of this application. If hired, a misrepresentation will be grounds for discharge.


I have been informed that North Central West Virginia Community Action Association is an Equal Employment Opportunity Employer and does not discriminate on the basis of race, sex, age, disability, veteran status, religion, sexual orientation, color or national origin.


Nothing on this application is intended to create or imply a contractual relationship. If I am hired, I understand that employment is “at will”, is not for any specific time period, and can be terminated with or without reason at any time.

Job Applicant Email Position Applyiing for:
Name: County:
Do you have a Driver's license? Are you at least 18 yrs old?
How did you hear about us? If not 18
Primary Phone Secondary Phone
County Other Names that you have gone by
       
Have you ever filed an application with us before Have you ever been employed with us before
Does your spouse, any of your friends or relatives or person living in your household work here Does a member of your family serve on the Board of Directors or Head Start Policy Council of NCWVCAA
Do you have a previous criminal Conviction Are you currently Employed
may we contact your present employer Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status
       
       
Highest level of Education High School
Undergraduate College Graduate - Professional  
Other Education      
       
Previous Work Experience Employer May we contact
Previous Work Experience Employer May we contact
Previous Work Experience Employer May we contact
       
Professional certifications and licenses Professional certifications and licenses
Professional certifications and licenses    
       
Describe any specialized training or skills

List professional business or civic activities

Other qualifications/Relevant Volunteer Activities/Comments
       
Personal/Professional Name
Personal/Professional Name
Personal/Professional Name
       
Are you capable of performing with or without reasonable accommodation(s), the essential functions of the position(s) for which you are applying? A review of the activities involved in such a job or occupation has been given.

Leave this empty:

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Signature Certificate
Document name: Job Application Consent Form
lock iconUnique Document ID: 0e475396b1d6d8969260e54fdcf9221edb35ed34
Timestamp Audit
August 9, 2022 10:21 pm EDTJob Application Consent Form Uploaded by Rob Everly - itadmin@ncwvcaa.org IP 147.0.246.114