Select Language
 
Click for accessibility options

Donate

 

Name

First:

Middle:

Last:

Present Address

Street:

City:

State:

Zip:

Permanent Mailing Address

Street:

City:

State:

Zip:

Telephone

Day:

Evening:

Are you 18 years or older?:
Military Status:

How did you hear about this position?

By whom were you referred?

Name of Website(s):

Name of Newspaper:

Do you have friends or relatives working here?:
If yes, please gives names and positions:

Residency

Are you either a U.S. Citizen or an Alien authorized to work in the United States?:
If hired, you will be required to submit, as a condition of employment, proof of your identity and legal work authorization within 3 business days.

Employment Desired & Site Location

Position:

Location:

Date you can start:

Type of hours desired:
Have you ever applied to CCI before?:
If yes, dates:
Have you ever been employed by CCI before?:
If yes, dates:
Can you travel if required by your job?:

Education

High School

Name and Location of School:

# Years Attended*:

Did You Graduate?:
Subjects Studied:

College

Name and Location of School:

# Years Attended*:

Did You Graduate?:
Subjects Studied:

Graduate, Trade, Business, Night, Correspondence

Name and Location of School:

# Years Attended*:

Did You Graduate?:
Subjects Studied:
*Do not provide dates. State and Federal laws prohibit discrimination on the basis of age.

General

Academic Honors, Awards, Special Recognition or Extra Curricular Activities:
Subjects of Special Study or Research:
Summarize Special Working Skills:

Employment History

Please complete in full even if you have a resume. List the last three employers, starting with the last one first. You may include military service or any verified work performed on a volunteer basis.

Employer 1

Name/Address/Phone of Employer. Include Contact Person or Supervisor:
Dates Employed and Position:
Reason for Leaving:

Employer 2

Name/Address/Phone of Employer. Include Contact Person or Supervisor:
Dates Employed and Position:
Reason for Leaving:

Employer 3

Name/Address/Phone of Employer. Include Contact Person or Supervisor:
Dates Employed and Position:
Reason for Leaving:

References

Give the names of three references, preferably three professional. Personal references, not related to you, whom you have known for at least one year, are acceptable.

Reference 1

Name:

Address:

Phone:

Reference 2

Name:

Address:

Phone:

Reference 3

Name:

Address:

Phone:

Emergency Information

In case of emergency, please notify:

Contact 1

Name:

Address:

Phone:

Contact 2

Name:

Address:

Phone:

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal and civil liability.

Applicant's Statement

  1. I understand that the receipt of this application does not imply that I will be employed.
  2. I certify that the answers given in this application are true and complete to the best of my knowledge. I understand that false or misleading information given in my application or interview(s) may result in withdrawal of a job offer or discipline up to and including termination of employment, whenever the omission or falsehood is discovered.
  3. I further understand and acknowledge that, if hired, any employment relationship with this Company is of an “at-will” nature, which means that I may resign at any time and the Company may discharge my employment at any time with or without cause. It is further understood that this “at-will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by a corporate officer of the Company. No manager, supervisor or other individual at the Company has authority to make a commitment of guaranteed or continuing employment to me, and no document or publication, including handbooks and policy manuals of the Company should be interpreted to make such a guarantee.
  4. I understand that Community Connections, Inc. will verify the statements and information contained in this Application. I agree to sign the proper authorization and release forms in regard to the Company’s verification and investigation of this information.
  5. I understand that if hired, I will be required to sign a Confidentiality Agreement as a condition of my employment with the Company.
My signature certifies that I have read and agree with the above statements.

Applicant Signature:

Date:

Support Us and Our Efforts

Through a person-centered approach, we design individualized programs that build on the strengths of the whole person, enabling them to live as independently as possible in their community.

We count on donors like you, so our clients can continue to reach their goals through therapies and activities.

Donate Now

 

Quick Links

What We Do
Locations
Donate
Fundraise
About
Contact

Turning 22
Events
Careers
News
Annual Reports
Advocate

Stay Connected

We don’t share your email. You can unsubscribe at any time.

* Name:
* Email:

Website by Morweb.org

Copyright 2022 | Privacy Policy | Transparency in Coverage |Sitemap