Employment Application

Thank you for your interest in working for our organization. In order to be considered for the position you are applying for, please thoroughly complete the fields below. You may submit a resume along with your completed application. Please type your responses in the spaces below.

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Ex. (123) 456-7890

Email *

Position Applying For: *

Employment Type Desired

Full-time
Part-time
Seasonal/Temporary
Internship

Available Start Date: *

Desired Salary *

Days/Hours Available for Work: *

Select the Upper Cumberland Counties you are available to work in: *

*If you selected "Referred by employee..." or "Other" above, please provide more information here:

Are you a US Citizen? *

Yes
No

Are you at least 18 years of age? *

Yes
No

Have you ever served in the US Armed Forces? *

Yes*
No

*If you answered "Yes" above, please list the branch of service, dates of service, rank, and job title below:

If selected, are you willing to submit to a pre-employment drug screening and/or background check? *

Yes
No

Have you ever been previously employed by UCDD/UCHRA? *

Yes*
No

*If you answered "Yes" above please list the position you held and the dates you worked for the agency:

Do you currently have any relatives working for UCDD/UCHRA or are you a member of any board/committee affiliated with UCDD/UCHRA? *

Yes*
No

*If you answered "Yes" above, please state the relative/board member/committee member name and relationship:

Are you able to travel if the job requires it? *

Yes
No

Has your driving license ever been suspended or revoked? *

Yes
No

Have you ever been convicted of a crime? *

Yes*
No

*If you answered "Yes" above please explain:

Education | School name/certifying institution, location, years attended, diploma/degree/certification, and major:

Additional certifications, training, etc.:

Employment History Information

Please provide your employment history in the fields below, beginning with your most recent/current employer.

1.) List your current/most recent job title in the field below along with a brief description of your role/responsibilities: *

Start Date *

End Date *

Supervisor's Name *

First

Last

Employer Phone Number *

Ex. (123) 456-7890

May we contact this employer? *

Yes
No

Additional Employment History Information

2.) List your next most recent job title in the field below along with a brief description of your role/responsibilities:

Start Date

End Date

Supervisor's Name *

First

Last

Employer Phone Number

Ex. (123) 456-7890

May we contact this employer?

Yes
No

Section Divider

3.) List your next most recent job title in the field below along with a brief description of your role/responsibilities:

Start Date

End Date

Supervisor's Name *

First

Last

Employer Phone Number

May we contact this employer?

Yes
No

Please list three professional/personal references from individuals who are not related to you.

References (1 of 3) *

Please list first and last name, job title, company/employer, location, and phone number.

References (2 of 3) *

Please list first and last name, job title, company/employer, location, and phone number.

References (3 of 3) *

Please list first and last name, job title, company/employer, location, and phone number.

Use the file uploader below to attach your resume to your application.

Upload your resume here:

Acceptable file extensions: .pdf, .doc, .docx

Signature *

Clear Signature

By signing, I certify that the information contained in this application is correct to the best of my knowledge.