APPLICATION FOR EMPLOYMENT

COMMUNITY BRIDGES IS COMMITTED TO STRENGTHENING OUR

DIVERSE COMMUNITY THROUGH INNOVATIVE HUMAN SERVICES. SINCE 1977, WE HAVE BEEN A CATALYST FOR A BRIGHTER FUTURE BY OPENING DOORS, OFFERING HOPE AND PROVIDING A HAND UP TO THE PEOPLE OF SANTA CRUZ COUNTY.

Thank you for your interest with Community Bridges. We are an equal opportunity employer and all applicants will be given equal consideration. Community Bridges does not discriminate against any applicant or employee because of race, color, age, sex, religion, disability, national origin, sexual orientation, marital status, veteran status, or any other legally protected status. Answers to application questions will be used for applicable, job- related reasons only. Incomplete applications will not be considered. 519 Main Street Watsonville, CA 95076- Telephone: 831-***-**** ext. 200, Fax: 831-***-**** Learn more at www.communitybridges.org

APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION (Please Print)

Last Name First Middle Initial Today’s Date

Street Address Phone Number

City State ZIP Code Alternative Phone Number

Other Name(s) Used E-Mail Address

Referred By (please be specific) Position(s) Applying for Do you have any relatives employed by this Company or its affiliates? If yes, give specifics:

Date Available

Would you be willing to relocate?

If yes, where?

Are you willing to travel?

If yes, up to what % of time?

Are you willing to work overtime?

Yes or No

Are you over the age of 18? Yes No If not, please provide your age: Have you signed an employment contract, confidentiality agreement or any other contract, which might affect your employment with Community Bridges? (If yes, please provide a copy to us.) Yes No Are you eligible to work in the United States? Yes No

[Proof of eligibility to work in the United States will be required before an individual can commence employment at Community Bridges]. U.S. Military or Coast Guard Service? Yes No Highest Rank: Driver's License Information: State: Number: Exp Date: Is Your driver's license restricted or suspended? Yes No If yes, give details:

**Please note that all candidates given a contingent job offer will be subject to a criminal background screening.**

EMPLOYMENT HISTORY (please list all previous employment, beginning with present or most recent. If additional space is required, attach a separate document). In addition, please account for all gaps in employment. Company Address Telephone

Position Title Hours per week Supervisor

Date (month/year)

From: To:

Reason For Leaving May we contact?

Duties and Responsibilities Eligible for Rehire?

Gaps in Employment (if any)

Company Address Telephone

Position Title Hours per week Supervisor

Date (month/year)

From: To:

Reason For Leaving May we contact?

Duties and Responsibilities Eligible for Rehire?

Gaps in Employment (if any)

Company Address Telephone

Position Title Hours per week Supervisor

Date (month/year)

From: To:

Reason For Leaving May we contact?

Duties and Responsibilities Eligible for Rehire?

Gaps in Employment (if any)

Company Address Telephone

Position Title Hours per week Supervisor

Date (month/year)

From: To:

Reason For Leaving May we contact?

Duties and Responsibilities Eligible for Rehire?

Gaps in Employment (if any)

PROFESSIONAL REFERENCES (Previous Supervisors Are Preferred) Name Name

Company Company

Telephone Telephone

Please describe business relationship, years known Please describe business relationship, years known Name Name

Company Company

Telephone Telephone

Please describe business relationship, years known Please describe business relationship, years known EDUCATION

Education Name & Address Major Degree/Certificate

High School

Community College/Trade

School

College/University

Graduate School

List other completed classes, academic honors, additional skills or training which may be applicable to your employment at this Company:

LANGUAGES

Language Specify Skill Level P = Poor F = Fair G = Good E = Excellent English Write Read Speak Studied Spanish Write Read Speak Studied Write Read Speak Studied COMPUTER I OFFICE SKILLS (if applicable)

Please enter proficiency level 1=Expert 2=Intermediate 3=Novice 4=Never Used Spreadsheets Word Processing Data Management Internet Project Management MS Outlook

List other hardware/software you can operate:

10-Key Fast Notes/Shorthand WPM List other office skills: CERTIFICATION

I certify that the information provided by me on this Application, accompanying resume, or any attachments that I have supplied, is true, correct and complete to the best of my knowledge and that any misrepresentation, omission, falsification or failure to disclose pertinent information will be cause for dismissal if hired. I authorize, consent and hold harmless my current and prior employers, educational institutions and persons or organizations named in this Application (or accompanying Resume) to release any information to Community Bridges that may be required to make an employment decision. This authorization will serve as a release of any and all information and for this purpose; a photocopy shall be considered an original and valid. I understand and agree that this Application is not a contract and that any acceptance of employment is not a contract of employment for a definite term. I understand that the Application will remain active for six (6) months. After that time, if I desire further consideration by Community Bridges, I will renew my Application in writing or in person. Applicant's Full Signature: Date:

Please indicate if you will need any of the following in order to participate in an oral interview. Favor de indicar si usted necesita alguno de los siguientes servicios para poder participar en una entrevista verbal. English/Spanish Translator

Intérprete Ingles/Español

An interview location that is wheelchair accessible An interview location that does not require the climbing of stairs Other

Affirmative Action Employment Questionnaire

Applicant: Please complete this form and submit it with your application. The form will be detached from your application and will be kept separate and confidential. This information is being gathered for the purpose of evaluating the effectiveness of Affirmative Action procedures, which this Agency uses to recruit applicants and measure their qualifications. The information will not be used in any way to make any employment decision that affects you. This information is an integral part of the Agency's Affirmative Action Program and is necessary to ensure equal opportunities for all. In addition, the collection of ethnic data to ensure equality is required by law. Position applied for: Date: I first learned of this job opening through (check one): A friend or relative

An organization or group (please specify) A job online posting, which website? A newspaper article, which paper? Other means (please specify) PERSONAL DATA FOR AFFIRMATIVE ACTION PURPOSES ONLY Age (check one): under 20 **-**-**-**-**-** 60 or older Sex (check one): Female Male Other Ethnic Data:

Black- African-American

Hispanic (includes all persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race, other than Europeans) American Indian/Native American/Alaskan Natives White (not of Hispanic origin)

Two or more races, not Hispanic or Latino

Asian, not Hispanic or Latino

Native Hawaiian or Other Pacific Islander, not Hispanic or Latino Other

Veteran Status

Disabled Veteran Vietnam Era Veteran

Are you disabled?

Hearing (5% or more loss in both ears)

Speech

Sight (use of eyeglasses which permit normal vision is excluded) Impairment due to amputation, loss of functions or coordination Other

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