YVEDDI provides equal opportunities for employment to all employees and job applicants. No person shall be discriminated against because of race, religion, color, sex, age, national origin, disability, political affiliation or veteran status. Application for Employment

Equal Opportunity Employer

Posted Position Job Opening Title: Date:

Hours of Availability Full-Time Part-Time Other

PERSONAL INFORMATION

Full Name:

Telephone:

Home

Address:

Cell

Resident County:

Email:

Name of any relative employed with

YVEDDI: Position:

Any relative on Board of Directors or a

Policy Council: Yes No Kinship:

Previous employment with YVEDDI: Yes No

Position Dates

Position Dates

Referred by:

TRAVEL

Travel in safe personal vehicle is required for most positions. N.C. Driver’s License # & State Residence in District or County may be required. Can you re-locate? Yes No

EDUCATION AND TRAINING

School & Location Major Course of

Study

Years

Completed Graduate? Degree Type

High School

Technical

College

Graduate

Military

Describe special skills (machines, repairs, counseling, etc) YVEDDI provides equal opportunities for employment to all employees and job applicants. No person shall be discriminated against because of race, religion, color, sex, age, national origin, disability, political affiliation or veteran status. EMPLOYMENT EXPERIENCE

Start with most current.

May we contact? Yes No

Employer: Supervisor:

Address: Telephone:

Duties:

Job Title:

Dates Employed:

Reason for Leaving: Last Pay Rate Per Hour:

May we contact? Yes No

Employer: Supervisor:

Address: Telephone:

Duties:

Job Title:

Dates Employed:

Reason for Leaving: Last Pay Rate Per Hour:

May we contact? Yes No

Employer: Supervisor:

Address: Telephone:

Duties:

Job Title:

Dates Employed:

Reason for Leaving: Last Pay Rate Per Hour:

May we contact? Yes No

Employer: Supervisor:

Address: Telephone:

Duties:

Job Title:

Dates Employed:

Reason for Leaving: Last Pay Rate Per Hour:

YVEDDI provides equal opportunities for employment to all employees and job applicants. No person shall be discriminated against because of race, religion, color, sex, age, national origin, disability, political affiliation or veteran status. REFERENCES

Please submit COMPLETE addresses.

(List non-related local persons that we can contact) Name: Name:

Address:

Address:

Telephone: Telephone:

Email Address: Email Address:

Name: Name:

Address:

Address:

Telephone: Telephone:

Email Address: Email Address:

I understand, before final job offer is made, some or all of the following may be required. 1. Background Check: We will conduct a National Criminal Background Check and investigate your Criminal Record, Address History, Social Security Number Validity, Sex Offender Search, Terrorist Watch List Report and we may check your Driving Record. 2. I understand that federal law prohibits the employment of unauthorized aliens; all persons hired must submit satisfactory proof of employment authorization and identity; failure to submit such proof will result in denial of employment. Satisfactory Pre-employment completion of I-9 form required to verify US citizenship of Legal Alien Resident status. 3. I will be required to submit to alcohol/drug testing on pre-employment, port-accident, random and/or “for cause” basis. 4. Satisfactory Pre-employment Affidavit required for no illegal on-the-job Drug Abuse. 5. Satisfactory Pre-employment Affidavit required for Child Abuse, Neglect, and Family Domestic Violence required for certain jobs. 6. Satisfactory Pre-employment Medical Examination and/or testing or immunizations required for certain jobs. 7. Satisfactory Pre-employment negotiations required for determining accommodations for any disability. 8. I understand that the employer follows an “employment at will” policy, in that I or the employer may terminate my employment at any time, or for any reason consistent with applicable state or federal law; this “employment at will” policy cannot be changed verbally or in writing, unless the change is specifically authorized in writing by the YVEDDI Board of Directors. I understand this application is not a contract for employment.

Other information that would be helpful in considering this application: Resume attached? Yes No

AFFIRMATION

I certify that all the statements herein are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal of employment.

By Applicant: Date:

YVEDDI provides equal opportunities for employment to all employees and job applicants. No person shall be discriminated against because of race, religion, color, sex, age, national origin, disability, political affiliation or veteran status. ATTACHMENT

For Human Resources Use Only

Name

Date

Position Applied For:

YVEDDI is an Equal Opportunity Employer. Applicants for employment are invited to self-identify for reporting purposes only. Please be advised that: (a) applicants are under no obligation to respond, but may do so in the future if they choose; (b) responses will remain confidential within the Human Resources Department; and (c) responses will be used only for reporting purposes only. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment. Please check all that apply

Race or Ethnic Identity Gender Veteran Status

Hispanic or Latino

White (not Hispanic or Latino)

Black or African American (not Hispanic or

Latino)

Native Hawaiian or Pacific Islander (not

Hispanic or Latino)

Asian (not Hispanic or Latino)

American Indian or Alaskan Native (not

Hispanic or Latino)

Two or More Races (not Hispanic or Latino)

Male

Female

Vietnam Era Veteran

Disabled Veteran

Special Disabled Veteran

Other Protected Veteran

Recently Separated Veteran

Armed Forces Service Medal Veterans

I do not wish to Self-Identify

Signature:

How did you hear of our opening?

Current Employee Newspaper Ad Indeed.com YVEDDI website Other: Revised 1/22/2020

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