Application

Employment Application
Instructions

Thank you for your interest in joining our team. Please complete the online employment application using the form provided on this page.

If you prefer, you may:

download and print the PDF version of the application,
complete it,
then scan and email the finished application to vramirez@spcaa.org.

We appreciate your interest and look forward to reviewing your application.

SPCAA Application for Employment

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of disability, or any other legally protected status.
Application Date:
mm/dd/yyyy
Position(s) Applied For:
Name
First Name
Middle Name
Last Name
Address
Address
Telephone and Email
Home Phone
Cell Phone
Other Phone
Email
Are you eighteen (18) years of age or older?

Yes
No
Are you legally eligible to work in the United States? (Documentation will be required if hired.)
Your Response

Yes
No
Do you have a valid driver's permit?

Yes
No
If so, what type?
Have you ever filled out an application here before?

Yes
No
If so, when did you last fill out an application?
mm/dd/yyyy
Have you ever been employed by SPCAA before?

Yes
No
If so, when was your last work session?
mm/dd/yyyy
Are you employed now?

Yes
No
If yes, may we contact your present employer?

Yes
No
What date would you be available to work?
mm/dd/yyyy
Availability work schedule (Check all that apply)

Full Time
Part Time
Health Provider
Are you willing to travel?

Yes
No
Are you related to anyone who is currently employed by South Plains Community Action?

Yes
No
If so, who?
What is your relationship to them?
Are you a parent of a child in the SPCAA Head Start program, have you ever volunteered with any division of SPCAA, or have you served on the board or any committee?
Your Response

Yes
No
If so, provide details
Have you been convicted of a felony within the last 7 years? (Conviction will not necessarily disqualify applicant from employment)
Your Response

Yes
No
If so, please explain
Do you have any current obligations as a result of conditions of probation or parole?

Yes
No
If so, please explain
Veteran of the U.S. Military?

Yes
No
If so, which branch?
Discharge Date
mm/dd/yyyy
Check any that applies

Vietnam Veteran
Disabled Veteran
Other (specify)
Indicate languages, other than English, you speak, read, and/or write
Education
High School or GED completed?

Yes
No
If no, provide highest grade completed
Colleges, Universities or Trade Schools attended
School Name
Address
Degree / Major
Years Attended
School Name
Address
Degree / Major
Years Attended
School Name
Address
Degree / Major
Years Attended
List any professional licenses or certifications, special certificates, skills, and/ or qualifications (CPR, first aid, computer skills, accounting, bookkeeping, etc.) that apply.
References
Please provide name, relationship and phone numbers of 3 personal references who are not related to you and are not previous employers.
Name
Years Known
Relationship
Phone Number
Email
Name
Years Known
Relationship
Phone Number
Email
Name
Years Known
Relationship
Phone Number
Email
References
Please provide name, relationship, and telephone numbers of 3 business references who are not related to you.
Name
Years Known
Relationship
Phone Number
Email
Name
Years Known
Relationship
Phone Number
Email
Name
Years Known
Relationship
Phone Number
Email
Employment History
Company
Phone Number
Email
Start Date
mm/dd/yyyy
End Date
mm/dd/yyyy
Address
Hourly Pay Start
Hourly Pay End
Position & Work Performed
Name & Title of Supervisor
Company
Phone Number
Email
Start Date
mm/dd/yyyy
End Date
mm/dd/yyyy
Address
Hourly Pay Start
Hourly Pay End
Position & Work Performed
Name & Title of Supervisor
Company
Phone Number
Email
Start Date
mm/dd/yyyy
End Date
mm/dd/yyyy
Address
Hourly Pay Start
Hourly Pay End
Position & Work Performed
Name & Title of Supervisor
If the position you are applying for requires proficiency testing, are you willing to take the test?
Your Response

Yes
No
SPCAA has a Drug-Free workplace policy. If you are employed, you may be required to submit a drug/alcohol test. If so are you willing to submit to drug/alcohol testing?
Your Response

Yes
No
In the last (2) years, have you tested positive or refused to test on any pre-employment drug/alcohol test?
Your Response

Yes
No
If employed, are you willing to allow a Criminal History Check to be conducted?

Yes
No
Application Statement
I certify that answers given herein are true and complete to the best of my knowledge.
I authorize the investigation of all statements contained in this application for employment as may be necessary in arriving at a decision and I agree to release all parties providing pertinent information from any and all liability from any damages which may result from the furnishings of such information. SPCAA only accepts applications for open positions. I understand that this application may be considered active for a period of up to 60 days. Job listings may be viewed on the SPCAA website at www.spcaa.org.
I understand that neither this document nor any offer of employment from the employer constitutes an employment contract. I also understand that SPCAA is an "at-will" employer and employees can be terminated at any time, with or without cause, and with or without notice. I also understand that no employment with SPCAA is for a fixed or definite term.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand that all SPCAA employees are required to abide by all rules and regulations of SPCAA. In addition, I understand that, if employed, my employer, South Plains Community Action Association, Inc., does not subscribe to Worker's Compensation Insurance.
I have not committed, or been convicted of committing a fraudulent act against SPCAA or any programs administered by SPCAA.
I understand that the electronic submission of this application or signature below indicates agreement to the Application Statement above.
Applicant Signature
Date
mm/dd/yyyy
An Equal Opportunity Employer and Programs. Auxiliary aids and services are available upon request to individuals with disabilities.
Security

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Application

Employment Application Instructions

Employment Application
Instructions