Job Application

Complete all REQUIRED fields before proceeding to each page of the Application
An Email will be sent for Electronic Signature with the email you provided.
Once starting the Job Application it will need to be completed.

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North Central West Virginia Community Action Association, Inc. is an equal opportunity employer. North Central West Virginia Community Action Association, Inc. does not discriminate on the basis of race, color, religion, creed, gender, national origin, age, disability, veteran status, or any other legally protected status.

Information

Email(Required)

Enter Email Confirm Email

Position Applying For(Required)

Date of Application

MM slash DD slash YYYY

County(Required)

Do you have a valid driver’s license?(Required)

Yes

Are you at least 18 yrs old?(Required)

Yes

Age if Under 18?

How Did You Learn About Us?(Required)

Employment Agency

Friend

Relative

Inquiry

Other

Contact Information

Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Primary Phone(Required)

Primary Phone Type(Required)

Home

Cell

Secondary Phone

Secondary Phone Type

Home

Cell

Other

County(Required)

Other Names That You Have Gone By

Previous addresses and dates for the past SEVEN years. When applicable, include addresses at which you resided while attending school.

From

MM slash DD slash YYYY

Address

City

State

Zip

From

MM slash DD slash YYYY

Address

City

State

Zip

Have you ever filed an application with us before?(Required)

Yes

If Yes, give date

Have you ever been employed with us before?(Required)

Yes

If Yes, give date

Does your spouse, any of your friends or relatives or a person living in your household work here?(Required)

Yes

If Yes, state name, relationship, and location

Does a member of your family serve on the Board of Directors or Head Start Policy Council of North Central WV Community Action?(Required)

Yes

If Yes, state name and relationship

Do you have a previous criminal conviction? (Conviction does not automatically disqualify an applicant from employment).(Required)

Yes

If Yes, state date(s) and nature of conviction (s)

Are you currently employed?(Required)

Yes

May we contact your present employer?(Required)

Yes

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status will be required upon employment)(Required)

Yes

Education

Highest Level of Education Attained(Required)

Less than High School/GED

High School/GED

Some College

Associates Degree

Bachelor's Degree

Graduate Degree

Doctorate

High School Name and Address

Course of Study/Major

Diploma or Type of Degree

Number of Years Completed

Graduated

Yes

Undergraduate College Name and Address of School

Course of Study/Major

Diploma or Type of Degree

Number of Years Completed

Graduated

Yes

Work Experience

Work Experience 1-3

Employer

Address

Telephone Numbers

Starting/Present Title

Supervisor

Reason for Leaving

Employed From:

MM slash DD slash YYYY

Employed To:

MM slash DD slash YYYY

May We Contact?

Yes

Job Duties

Work Experience 2-3

Employer

Address

Telephone Numbers

Starting/Present Title

Supervisor

Reason for Leaving

Employed From:

MM slash DD slash YYYY

Employed To:

MM slash DD slash YYYY

May We Contact?

Yes

Job Duties

Work Experience 3-3

Employer

Address

Telephone Numbers

Starting/Present Title

Supervisor

Reason for Leaving

Employed From:

MM slash DD slash YYYY

Employed To:

MM slash DD slash YYYY

May We Contact?

Yes

Job Duties

List professional certifications and licenses

Type of certificate/license

Issuing Authority

Issue Date

MM slash DD slash YYYY

Expiration Date

MM slash DD slash YYYY

Type of certificate/license

Issuing Authority

Issue Date

MM slash DD slash YYYY

Expiration Date

MM slash DD slash YYYY

Type of certificate/license

Issuing Authority

Issue Date

MM slash DD slash YYYY

Expiration date

MM slash DD slash YYYY

Describe any specialized training or skills

List professional, business or civic activities

Please exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other legally protected status.

Additional Information: Other Qualifications/Relevant Volunteer Activities/Comments

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE REVIEWED THE ESSENTIAL FUNCTIONS OF THE POSITION(S) FOR WHICH YOU ARE APPLYING.

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.(Required)

Yes

Personal/Professional References Include a minimum of one professional reference. Do Not include family members or past or current supervisors.

Personal/Professional

Name

Address

Phone Number

Best Time to Call

Occupation

Personal/Prefessional

Name

Address

Phone Number

Best Time to Call

Occupation

Personal/Professional

Name

Address

Phone Number

Best Time to Call

Occupation