Pride CAS Employment FormPlease enable JavaScript in your browser to complete this form.Personal InformationAll applicants are considered for all positions without regard to race, religion, color, sex, gender, sexual orientation, pregnancy, age, national origin, ancestry, physical/mental disability, medical condition, military/veteran status, genetic information, marital status, ethnicity, citizenship or immigration status, or any other protected classification, in accordance with applicable federal, state, and local laws.Name *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *PhoneIf under 18 years of age, do you have a work permit? *YesNoAre you legally eligible for employment in the United States? *YesNoIn compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required I-9 employment eligibility verification document form upon hire.Employment DesiredPosition(s) Applying For *Date you can startHave you ever worked for Pride CAS before? *YesNoWhenSupervisorReason for leavingDesired SalaryEducationHighest Grade Completed:1st2nd3rd4th5th6th7th8th9th10th11th12thCollege 1College 2College 3College 4Name of last school attendedDegree Obtained.License, Vocational or Trade TrainingProfessional ReferencesPlease give the names of three persons not related to you, whom you have known professionally at least three years.Reference 1Name, Email, Phone, Years KnownReference 2Name, Email, Phone, Years KnownReference 3Name, Email, Phone, Years KnownMay we contact your present employer at this time?YesNoWork ExperienceList all your work experience (starting with your most recent employer). Please account for all periods of unemployment in this section. You may attach additional sheets of paper.Employer 1(1) Employed From (1) Employed ToName of Employer 1Address of Employer 1Phone of Employer 1Job Title of Employer 1Name of Supervisor of Employer 1Briefly describe your job duties and work experience (1)Employer 2(2) Employed From(2) Employed ToName of Employer 2Address of Employer 2Phone of Employer 2Job Title of Employer 2Name of Supervisor of Employer 2Briefly describe your job duties and work experience (2)Employer 3(3) Employed From(3) Employed ToName of Employer 3Address of Employer 3Phone of Employer 3Job Title of Employer 3Name of Supervisor of Employer 3Briefly describe your job duties and work experience (3)Applicant’s StatementPlease Note: All applicants are considered for all positions without regard to race, religion, color, sex, gender, sexual orientation, pregnancy, age, national origin, ancestry, physical/mental disability, medical condition, military/veteran status, genetic information, marital status, ethnicity, citizenship or immigration status, or any other protected classification, in accordance with applicable federal, state, and local laws.I understand and agree that nothing in this application shall constitute an offer, a contract or a guarantee of employment for a specific period of time. If hired, I understand that my employment with the Company is on an at-will basis, which means that my employment may be terminated with or without cause and with or without notice at any time, at the will the Company or me. I further understand that no representative or agent of the Company, other than the President, has the authority to enter into any agreement for employment for any specific period of time or to make an agreement contrary to the foregoing. I also understand that any agreement modifying my at-will employment status must be in writing and signed by the President. I give the Company permission to contact all or any of my previous employers and references and authorize them to disclose any information the Company may request in the course of its investigation of this application for employment and I hereby release the Company and such references and prior employers from any and all liability with respect to such disclosures.After a tentative offer of employment has been made, if requested by the Company, I agree to take a job-related medical examination at no personal expense and authorize the examining physician to disclose the findings to the Company. I understand that any offer of employment is conditioned upon receipt of satisfactory references and satisfactory completion of any such job-related medical examination. I also understand that I may be requested now or at any subsequent time during my employment with the Company to submit to drug and/or alcohol tests, at the Company’s expense. I understand that if I refuse to take the test, my employment may be terminated immediately. I also understand that if a conditional offer of employment is made, the Company performs criminal background checks. A criminal conviction will not necessarily exclude me from consideration. Rather, each situation will be addressed on an individual basis, consistent with applicable law.I have provided truthful and complete responses to all inquiries in the application and authorize the Company to investigate all statements contained in the application. I understand that the discovery of any falsification or omission constitutes a ground for immediate dismissal or refusal to hire. If employed, I will abide by the Company’s rules and regulations, which I understand are subject to change by the Company.Date *Submit43790
