Application for Employment

Gulf Coast Community Services Association is an Equal Opportunity Employer. Applicants will be considered for all positions without regard to race, color, religion, sex, national origin, age, disability, marital or veteran status.

INSTRUCTIONS:
    1. Check the job announcement for requirements. Submit resume
      and supporting documentation as required to recruiter@gccsa.org.
    2. Complete an application for each position.
    3. Type or click information for each field.
    4. Press the SUBMIT button when application form is complete.

Personal Information

Name: ,
Last Name
First Name
Middle
Address:
Street Address
Apt #
City
State
Zip
Telephone:
Area Code
Number
Email Address:

Are you legally authorized to work in the United States in order to be employed by GCCSA?         

Have you filed an application before?              If yes, give date
 
Have you worked for this agency before?              If yes, give date
 
Are you a Veteran of the U.S. Military Service?              If yes, give date
 
Are you currently or previously a Head Start parent?              If yes, give date

Job Position

What Job are you applying for:         
Starting Wage expected:           When could you report to work:   

Education

    
High
College/University
Graduate/Professional
 School Name      
 Years Completed                        
*Diploma/Degree      
 Describe Course of Study   
Must provide copy of Diploma/Degree or official transcripts

Licenses

List licenses, certificates or other authorizations you hold in a trade or profession.
Type of License License Number Exp. Date State Granted By (Licensing Board)
       
       
       
       

Do you have any physical, mental, or medical impairment or disability that would limit your job performance for the position for which you are applying?       

If Yes, explain

Conviction Record

Have you ever been convicted of, or have you pleaded guilty to or no contest to a felony or misdemeanor?
    

If Yes, please indicate the nature of the offense, date, court and disposition. If felony, list date and give terms of sentence.

Employment Experience

Start with your present or most recent employment position, account for all periods of employment and unemployment. If you were employed in any position under a different name, give in each position the name used. Include military service assignments and volunteer activites.
Employer
  
Address
  
Telephone
  
Job Title
  
Date Employed
From
  
To
  

Hourly Rate/Salary
Starting
  
Final
  
Work Performed
Supervisor

Reason for Leaving
Employer
  
Address
  
Telephone
  
Job Title
  
Date Employed
From
  
To
  

Hourly Rate/Salary
Starting
  
Final
  
Work Performed
Supervisor

Reason for Leaving
Employer
  
Address
  
Telephone
  
Job Title
  
Date Employed
From
  
To
  

Hourly Rate/Salary
Starting
  
Final
  
Work Performed
Supervisor

Reason for Leaving
Employer
  
Address
  
Telephone
  
Job Title
  
Date Employed
From
  
To
  

Hourly Rate/Salary
Starting
  
Final
  
Work Performed
Supervisor

Reason for Leaving


 Are you presently employed?         

May we communicate with your present employer?         

Please account for period(s) of unemployment. Give dates and reasons

Please list any additional skills such as languages, computer, etc, that you feel will add value to this position.

Relative Clause: Sections 703.01 and 703.02 GCCSA Personnel Policies

No applicant shall be hired to a position with this agency while he or she or any member of his/her immediate family is a member of the GCCSA Board of Directors. Further, no employee shall hold a position with this agency in which a member of his or her immediate family exercises supervisory authority over that particular employee. However, when GCCSA cannot adequately staff positions without hiring such an individual, our agency may deviate from this policy. Futhermore, employment records must provide evidence that no other individual within the service area is qualified and available for employment.

Do you or your spouse have a relative working at the agency?         

If yes, type the name below.

Name of Relative      Relationship
(Failure to give name of a relative as indicated above may result in immediate termination)

Agreement

I certify that all answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision

In the event of employment, I understand that false or misleading information given on my application and/or interview(s) may result in termination of employment. I understand, also, that I am required to abide by all GCCSA personnel polices, rules and regulations.


Type "I AGREE"              Date