Date of Application:
Position: GEAR-UP AdvisorChief Program Officer
Referred By:

Name:


Address:


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Telephone No.:

Email Address:
What date could you start work?

Have you ever been convicted of a Crime?YesNo
If yes, state nature of offense, when, where and disposition.

(A conviction will not necessarily bar hiring. This information will be used only for job-related purposes and only to the extent permitted by applicable law.)

High School:

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College or University:

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Other:

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Are you pursing or planning to purse further studies?YesNo
If so, please describe:
How did you hear about CYC and the opportunities at CYC?

List all employers in order, last or current employer first. Explain any gaps in your employment history.

Are you currently employed?YesNo

Employer:
Location:
Position Title:
Dates Employed:
From:
To:
Supervisor:
Phone No.:
May we contact?YesNo
Reason for wanting to make change (state whether you left employment voluntarily or involuntarily):

Employer:
Location:
Position Title:
Dates Employed:
From:
To:
Supervisor:
Phone No.:
May we contact?YesNo
Reason for leaving (state whether you left employment voluntarily or involuntarily):

Employer:
Location:
Position Title:
Dates Employed:
From:
To:
Supervisor:
Phone No.:
May we contact?YesNo>
Reason for leaving (state whether you left employment voluntarily or involuntarily):

Salary Expectations:
Minimum Requirements:

Please answer the following in the space provided.

What motivates you the most?
Describe your ideal job?
What attracted you to this position?
Describe your unique skills, knowledge & experience and why you feel you are a top candidate with CYC?

Resume
Cover Letter

I certify that information given in this employment application is true and complete to the best of my knowledge. I understand that false, misleading, or incomplete information given in my application or interview(s) may disqualify me from further consideration or may lead to my dismissal from employment if I am hired. I agree to notify immediately the management of CYC if I ever am convicted of a felony, or any crime involving dishonesty or any workplace substance abuse or drug use, possession or trafficking either while my job application is pending or during my period of employment, if I am hired.

I authorize the investigation of all statements contained in this application (and accompanying resume, if any). I also authorize CYC to contact my present and past employers (unless otherwise noted in this application form), and I authorize any person, school, current or past employer(s), and organizations named in this application form to provide CYC with relevant information and opinions that may be useful in making a hiring decision.

In consideration of my employment, I agree to comply with the policies, rules, regulations and procedures of CYC and will sign CYC’s agreements pertaining to such policies. I understand that neither this application nor any statement made to me during any pre-employment discussions with CYC can create a contract of employment. I understand that employment by CYC is not to be construed as creating a binding contract and that my employment and compensation can be terminated with or without cause or notice, at any time, at the option of either CYC or myself.