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.

If you prefer to print this application, click here to print.


Application date:
Position(s) Applied For:

Name


First
Middle
Last
Maiden (if Applicable)

Address


Address


City

State

Zip

Telephone


Home
Cell
Other

Education


High School or GED completed?
    If no, provide highest grade completed.
Colleges, Universities or Trade Schools attended
Name of School
City/State
Degree/Major
Years Attened

Name of School
City/State
Degree/Major
Years Attened

Name of School
City/State
Degree/Major
Years Attened

Name of School
City/State
Degree/Major
Years Attened


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
DayTime Telephone

Name
Years Known
Relationship
DayTime Telephone

Name
Years Known
Relationship
DayTime Telephone

Please provide name, relationship, and telephone numbers of 3 business references who are not related to you.

Name
Years Known
Relationship
DayTime Telephone

Name
Years Known
Relationship
DayTime Telephone


Employment History


Company
Telephone
Dates of Employment
From

To


Address
Hourly Pay
Start

End

Position & Work Performed
Name & Title of Supervisor


Company
Telephone
Dates of Employment
From

To


Address
Hourly Pay
Start

End

Position & Work Performed
Name & Title of Supervisor


Company
Telephone
Dates of Employment
From

To


Address
Hourly Pay
Start

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?
SPCAA has a Drug-Free work place policy. If you are employed, you may be required to submit a drug/alcohol test. If so are you willing to take submit to drug/alcohol testing?
In the last (2) years, have you tested positive or refused to test on any pre-employment drug/alcohol test?
If employed, are you willing to allow a Criminal History Check to be conducted?


Application Statement


I certify that 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 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 application 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 “atwill” 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 Applicant Statement above.

Applicant Signature
Date