Community Integration Specialist | Bridging Community Resources

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Application Form

Community Integration Specialist

Application For Employment

All applicants are considered for all positions without regard to race, religion, color, sex, gender, sexual orientation, pregnancy, age, national origin, ancestry, physical/mental disability, severe/morbid obesity, medical condition, military/veteran status, genetic information, marital status, ethnicity, alienage or any other protected classification, in accordance with applicable federal, state, and local laws. By completing this application, you are seeking to join a team of hardworking professionals dedicated to consistently delivering outstanding service to our customers and contributing to the financial success of the organization, its clients, and its employees. Equal access to programs, services, and employment is available to all qualified persons. Those applicants requiring accommodation to complete the application and/or interview process should contact a management representative.

Position Applying For

Date of Application

Full Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Alternate Phone

Email(Required)

Employment Experience

Please list the names of your present or previous employers in chronological order with present or most recent employer listed first. Be sure to account for all periods of time. If self-employed, give firm name and supply business references. Add additional page if necessary.

Name of Employer

Supervisor(Required)

May we contact?(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Dates Employed: From(Required)

MM slash DD slash YYYY

Dates Employed: To(Required)

MM slash DD slash YYYY

Job Title(Required)

Responsibilities(Required)

Reason For Leaving(Required)

Name of Employer

Supervisor(Required)

May we contact?(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Dates Employed: From(Required)

MM slash DD slash YYYY

Dates Employed: To(Required)

MM slash DD slash YYYY

Job Title(Required)

Responsibilities(Required)

Reason For Leaving(Required)

Name of Employer

Supervisor(Required)

May we contact?(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Dates Employed: From(Required)

MM slash DD slash YYYY

Dates Employed: To(Required)

MM slash DD slash YYYY

Job Title(Required)

Responsibilities(Required)

Reason For Leaving(Required)

Have you ever been involuntarily terminated or asked to resign from any job?(Required)

Please explain(Required)

Please explain any gaps in your employment history

Please list any other experience, job related skills, additional languages, or other qualifications that you believe should be considered in evaluating your qualifications for employment

Education

Please describe your educational background in the fields provided below

High School

Years Completed(Required)

Did you graduate?(Required)

Area of Study/Major

Specialized Training, Skills, or Extra-Curricular Activities

College/ University

Years Completed(Required)

Did you graduate?(Required)

Area of Study/Major(Required)

Specialized Training, Skills, or Extra-Curricular Activities

Graduate/ Professional School

Years Completed(Required)

Did you graduate?(Required)

Area of Study/Major(Required)

Specialized Training, Skills, or Extra-Curricular Activities

Trade School

Years Completed(Required)

Did you graduate?(Required)

Area of Study/Major(Required)

Specialized Training, Skills, or Extra-Curricular Activities

Other

Years Completed(Required)

Did you graduate?(Required)

Area of Study/Major(Required)

Specialized Training, Skills, or Extra-Curricular Activities

Personal References

Please list three people who know you well

Name and Title(Required)

Relationship(Required)

Phone(Required)

Name and Title(Required)

Relationship(Required)

Phone(Required)

Name and Title(Required)

Relationship(Required)

Phone(Required)

Business and Professional References

Please list three professional references of individuals who are not related to you

Name and Title(Required)

Relationship(Required)

Phone(Required)

Name and Title(Required)

Relationship(Required)

Phone(Required)

Name and Title(Required)

Relationship(Required)

Phone(Required)

General Information

Have you ever used another name?(Required)

Is any additional information relative to name changes, use of an assumed name, or nickname necessary to enable a check on your work and educational record?(Required)

If yes to either of the above, please explain(Required)

Have you ever worked for this company before?(Required)

Please give dates and position(Required)

Do you have friends and/or relatives working for this company?(Required)

Name(s) and relationship(s)(Required)

On what date are you available to begin work?(Required)

MM slash DD slash YYYY

Days/Hours available to work

Monday

Monday

Monday hours(Required)

Tuesday

Tuesday

Tuesday hours(Required)

Wednesday

Wednesday

Wednesday hours(Required)

Thursday

Thursday

Thursday hours(Required)

Friday

Friday

Friday hours(Required)

Saturday

Saturday

Saturday hours(Required)

Sunday

Sunday

Sunday hours(Required)

Are you available to work?(Required)

Full-time

Part-time

Shift Work

Temporary

If hired, would you have a reliable means of transportation to and from work?(Required)

Can you travel if the position requires it?(Required)

Can you relocate if the position requires it?(Required)

Are you at least 18 years old?(Required)

Note: If under 18, hire is subject to verification that you are of minimum legal age.

If hired, can you present evidence of your identity and legal right to work in this country?(Required)

Are you able to perform the essential job functions of the job for which you are applying with or without reasonable accommodation?(Required)

Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for qualified applicants/employees to perform essential job functions.

Applicant Statement and Agreement

Please read and initial each paragraph below. If there is anything that you do not understand, please ask

I hereby authorize the Company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to the Company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.(Required)

I hereby authorize the Company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to the Company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.*

In the event of my employment with the Company, I understand that I am required to comply with all rules and regulations of the Company.(Required)

In the event of my employment with the Company, I understand that I am required to comply with all rules and regulations of the Company.*

If hired, I understand and agree that my employment with the Company is at-will, and that neither I, nor the Company is required to continue the employment relationship for any specific term. I further understand that the Company or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications.(Required)

If hired, I understand and agree that my employment with the Company is at-will, and that neither I, nor the Company is required to continue the employment relationship for any specific term. I further understand that the Company or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications.*

I understand that safety of employees is extremely important to the Company and that the Company is committed to ensuring a safe working environment. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my site supervisor. I understand and agree to comply with federal, state, and local regulations related to on-the-job safety and health.(Required)

I understand that safety of employees is extremely important to the Company and that the Company is committed to ensuring a safe working environment. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my site supervisor. I understand and agree to comply with federal, state, and local regulations related to on-the-job safety and health.*

I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.(Required)

I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.*

I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration laws require me to complete an I-9 Form in this regard.(Required)

I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration laws require me to complete an I-9 Form in this regard.*

I understand that if any term, provision, or portion of this Agreement is declared void or unenforceable, it shall be severed and the remainder of this Agreement shall be enforceable.(Required)

I understand that if any term, provision, or portion of this Agreement is declared void or unenforceable, it shall be severed and the remainder of this Agreement shall be enforceable.*

Please Note: After clicking the Submit button, you will be immediately redirected to the form summary/signature page. This form will not be completed until it has been signed at the bottom of that page (next to the big blue arrow). If you have any issues, please contact info@mybcr.org

Do you have Questions? Call or visit us.

818.843.4907

230 E. Amherst Drive
Burbank, CA 91504

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