Information And Referral Outreach Specialist - Employment Application (Page 4 of 4) in pdf

Information And Referral Outreach Specialist - Employment Application Page 4

Have you been convicted of or pleaded no contest to a felony within the last five years?*

Yes:

No:

If yes, please explain:

Have you been convicted of, pleaded guilty to, or pleaded no contest to, a misdemeanor petty theft,

burglary, fraud, writing bad checks, and other related crimes within the last five years? *

Yes:

No:

If yes, please explain:

*Conviction of a crime, or pleading guilty to a criminal charge, will not necessarily disqualify you from the job

for which you are applying. Each conviction or plea will be considered with respect to time, job relatedness, and

other relevant factors.

Agreement of the Transfer of Information:

I declare the information provided by me in this application is true, correct, and complete to the best

of my knowledge. I understand that if employed, any falsification, misstatement, or omission of fact

in connection with my application, whether on this document or not, may result in immediate

termination of employment. I authorize you to verify any and all information provided above.

I acknowledge that if I become employed, I will be free to terminate my employment at any time for

any reason, and that CIELO Project retains the same rights. No CIELO representative has the

authority to make any contrary agreement.

Signature:

Date

Printed Name:

P r o m o t i n g C o m m u n i t y , S e l f - s u f f i c i e n c y , a n d L e a d e r s h i p

Information And Referral Outreach Specialist - Employment Application Page 4