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
Are you eighteen (18) years of age or older?
Are you legally eligible to work in the United States?(Documentation will be required if hired)
Do you have a valid drivers permit?
    If so, what type?
Have you ever filled out an application here before?
    If so did you last fill out an application?
Have you ever been employed by SPCAA before?
    If so, when was your last Work session?
Are you employed now?
If yes, may we contact your present employer?
What date would you be available to work?
Availability work schedule check all that apply.
FullTime PartTime Health Provider
Are you willing to travel?
Are you related to anyone who is currently employed by South Plains Community Action?
    If so Who?     Relationship
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?
    If so, provide details
Have you been convicted of a felony within the last 7 years? (Conviction will not necessarily disqualify applicant from employment)
    If so, provide details
Do you have any current obligation as a result of conditions of probation or parole?
    If so, please explain
Veteran of the U.S. Military?
    If so, which branch?     Discharge Date:
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?
    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

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
 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

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