Employment Application PIC Employment Application Date* First Name* Last Name* Street Address* City* State & Zip Code* County* Email Address* Best Phone Number* Position Applying for:* Date available to start: Referral Source Newspaper School CareerLink Internet Job Site PIC Website Employee Referral Name of Employee Referral (If applicable): Have you ever interviewed at PIC or any of its divisions before? Yes No If yes, please give date(s): Have you ever been employed at PIC or any of its divisions before? Yes No If yes, please give date(s): If previously employed by PIC, which division? Reason(s) for leaving? Do you have any relatives currently working for PIC? Yes No Do you have adequate transportation to your job? Yes No Will you be able to show at time of hire that you are authorized to work in the United States? Yes No Have you been convicted of or pleaded guilty to a felony or misdemeanor (an answer of "yes" to this question WILL NOT disqualify you from consideration for employment)? Yes No If yes above, please explain: Do you have current Child Abuse Clearance? Yes No Do you have current Criminal Record Clearance? Yes No Do you have current FBI Clearance? Yes No EDUCATIONAL INFORMATIONAre you a High School Graduate? Yes No Training & Educational Record*School(s) AttendedDate StartedDate EndedCourse / MajorYear Graduated PLEASE HIT PLUS SIGN (+) TO ADD MORE ROWS Note any specialized training / honors / extra-curricular activities, etc:WORK HISTORYHave you been employed in the last six (6) months? Yes No Please List Employer Information*Name of EmployerPhone numberJob TitlePrimary DutiesStart DateEnd DateHours per WeekHourly Wage or Salary?Reason for Leaving?Name of Supervisor?May we Contact Employer? PLEASE HIT PLUS SIGN (+) TO ADD MORE ROWS Were you ever disciplined, warned, or counseled about job performance, absenteeism, tardiness, or policy violations at any job listed above? If yes please explain: Can you perform the essential functions of the job or jobs you are applying for, with or without a reasonable accommodation?* Yes No Please Complete the following, if applicable, for the position you are applying for:Typing at least 35 WPM? Yes No Experience working with pre-schoolers? Yes No Any safety training? Yes No Any first aid training? Yes No Are you CPR certified? Yes No Any food service training? Yes No Experience using a Personal Computer? Yes No Experience using Microsoft Word? Yes No Experience using Microsoft Excel? Yes No Experience with data entry? Yes No Do you speak a foreign language? Yes No Do you have a valid CDL License? Yes No If yes to CDL license, what class? Passenger Endorsement? Any other training or skills applicable to the job being applied for? List any other schooling or training, including training received in the armed forces, which may relate to the type of job you are seeking. Please include any job related certificates or licenses you hold or any other job related equipment you operate.List any professional licenses or certificates.Please upload Resume here:*Max. file size: 50 MB.References: Two of your three references need to be professional references and one can be personal but not related. Please list three:*NamePhone NumberYears KnownReferences:*NamePhone NumberYears KnownReferences:*NamePhone NumberYears KnownThe Private Industry Council of Westmoreland / Fayette, Inc. (the "Agency") is an equal opportunity employer. The Agency does not discriminate against any applicant for employment or any employee because of the individual's race, color, religion, sex, age, national origin, disability, or other legally protected status. I certify that the information given on this application (and accompanying resume, if any) is true and complete to the best of my knowledge, and that I have not knowingly withheld any fact or circumstance. I fully understand and agree that any false statement or misrepresentation contained herein will fully justify and, at the option of the Agency, may cause my dismissal from employment, regardless of the time when any statement may be found to be false or a misrepresentation. I authorize the Agency to investigate and verify any and all information contained in my application for employment supplied at the pre-employment interview; including but not limited to, prior work, education, and criminal history. I understand and agree that any offer of employment the Agency may make to me (and if I am hired, my continued employment) will be contingent upon my submission of evidence verifying that I am authorized to work and upon my written consent to investigation of my criminal records, if any. One of the requirements for consideration of employment with this Agency is the satisfactory passing of a pre-employment physical and urine drug test. I further understand that if illegal drugs are found in my system, my employment consideration will be withdrawn. If employed, I will be required to comply with the Agency drug and alcohol policy, including consent to drug and alcohol testing under certain conditions. I agree to abide by all present and subsequently issued personnel policies and rules. I understand that the Agency may, at any time, make unilateral changes in any of its policies, practices, rules, procedures, compensation and benefits. I understand that if I am hired, there is no guarantee of employment for any designated term. I understand that if I am employed by the Agency, my employment is "at will," that I or the Agency may terminate the employment relationship at any time, for any reason, with or without notice.* I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE STATEMENTS AND UNDERSTAND EACH AND ALL OF THESE STATEMENTS CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
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