Fillable Printable Electronic Internal Application Form
Fillable Printable Electronic Internal Application Form
Electronic Internal Application Form
COMMUNITY ACTION OF SOUTHERN KENTUCKY, INC.
INTERNAL APPLICATION FOR EMPLOYMENT
P.O. BOX 90014 ATTENTION: HUMAN
RESOURCES
BOWLING GREEN, KENTUCKY
42102-9014
AN EQUAL OPPORTUNITY
EMPLOYER
Position Applied For:____________________________ Current Salary:______________ Salary Requirement:________________
P E R S O N A L
Last Name: First Middle
Date
/ /
Street Address
Home Telephone
( )
City, State, Zip
Business Telephone
( )
T r a i n i n g
Special knowledge or skills (languages, machine operations, etc.)
Specialized Training, Apprenticeship, and Extra-Curricular Activities:
Degree:
Type:
Why are you interested in this position?
Why do you think you are qualified for this position?
List any special skills that would aid you in this position.
REFERENCES
Give name, address, and telephone number of three job-associated references who are not related to you.
Name
Address/City/State
Telephone
Occupation
APPLICANTS CERTIFICATION
I understand that receipt of this application does not imply that I will be employed nor does it indicate that there
are positions available.
I understand I will be asked for information that will allow Community Action of Southern Kentucky, Inc. to comply
with immigration and naturalization requirements.
I understand that by submitting this application, I am granting Community Action of Southern Kentucky, Inc. permission
to investigate any of the information included in this application. I agree to cooperate in such investigation and
release from all liability or responsibility all persons, organizations, companies and corporations collecting and
supplying such information.
I understand that if I am hired my employment is for no definite period and will be at-will and may be terminated with
or without cause and with or without notice at any time. I further understand that if I am hired my job will
include any duties and tasks requested or directed by management, regardless of my job title. I understand that
absent
a
written, signed contract my employment will remain at will, regardless of promotion, demotion or change of
position.
I
certify the information included in this application is correct and understand that misrepresentation of false or
omitted facts, whenever discovered, may result in rejection of this application or dismissal from employment.
I understand and agree that should I secure employment with Community Action, I will return to any current or past
employer, all confidential and proprietary information that is appropriately theirs. Further, I agree to not bring
with me, share, or utilize any confidential or proprietary information for use at Community Action
I understand that Community Action of Southern Kentucky, Inc. is required, due to the competitive nature of its
business and various contractual agreements with certain clients and vendors, to give notice to all employees of the
confidential nature of its processes, computer programs, systems and related information which I may become
knowledgeable of or may have access to in the course of my employment, and understand that any violation of such
confidences may result in termination of my employment .
Date
****************************************************************************************************************
AGENCY USE ONLY:
Current Attendance Record:
Days Missed
Remarks:
References:
Current
Supervisor_______________________ Comments________________________________________________________
Arrange 1
st
Interview ___Yes ___No Date______________ Position Interviewed For:__________________________
Interviewer________________________________________ Interviewer____________________________________________
Interviewer________________________________________ Interviewer____________________________________________
Arrange 2nd Interview ___Yes ___No Date______________ Position Interviewed For:__________________________
Interviewer________________________________________ Interviewer ___________________________________________
Interviewer________________________________________ Interviewer____________________________________________
Recommend for employment extended Yes No. Offer accepted Yes No
Job
Title
Salary $ (hr/mo/yr) (Circle One)
G:\Forms\HR Forms\Application and Interview Forms (Front Desk)\Internal Application Form.doc
Rev. 3/2009