CCNB Corpsmember Employment Application

An Equal Opportunity Employer

Personal Information

Name

Last Name:
First Name:
Middle:
Date of Birth:
Home Phone:
Cell Phone:
Email Address:

Present Address

Street Address
City
State
Zip code

Permanent Address
Same as Present Address

Street Address
City
State
Zip code

General Information

Position/Program I am applying for:  
How did you hear about this position?
Have you ever worked for Conservation Corps North Bay before?     YesNo
If yes, state when and who was your supervisor below?
Do you have friends and/or relatives working for Conservation Corps North Bay?     YesNo
If yes, state their names and relationships to you below.
CONSERVATION CORPS NORTH BAY is a job-training program for youth between the ages of 18 – 28 years. Applicants over 28 years of age are considered for employment by referral only.
If you are not between the ages of 18-28 years, please explain below.
If hired, would you have a reliable means of transportation to and from work?     YesNo
If hired, can you present evidence of your US citizenship or proof of your legal right to live and work in the United States.     YesNo
Valid California Drivers License     YesNo Other
This position may require extensive and repetitive physical activity e.g., heavy lifting, bending.
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?     YesNo
If no, describe the functions that cannot be performed below
Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination and to skill and agility tests.
Have you ever been convicted of a criminal offense (felony or misdemeanor)? Convictions for marijuana-related offenses that are more than two years old need not be listed.     YesNo
If yes, state nature of the crime(s), when and where convicted, and disposition of the case below.
Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.

Education, Training, & Experience

Name and Address (including city, state and zip code) Number of years completed Graduated Degree / Diploma / Area of study
High School Yes
No
College / Vocational Yes
No
College / Vocational Yes
No
Other Yes
No
What is the highest grade level you have completed:
Do you have a (check one):     Highschool DiplomaGED or equivalentneither
If neither, are you interested in completing your high school diploma or GED     YesNo
Do you speak, write, or understand any foreign language(s)listed below.     YesNo
If yes, which language(s)?
Do you have other experiences, training, qualifications, and/or skills, which you feel make you especially suited for work at Conservation Corps North Bay.     YesNo
If so, please explain

Employment History

List all present and past employment starting with your most recent employer. Account for all periods of unemployment. You must complete this section even if including a resume.

Most recent employer

Name of Employer
Phone Number
Address including number, street, city, state, zip
Supervisors Name
Reason for leaving
Date employed from: to:
Hourly Wage: Hours per week:
Your Position & Duties
May we contact this employer for a reference?YesNo

Next most recent employer

Name of Employer
Phone Number
Address including number, street, city, state, zip
Supervisors Name
Reason for leaving
Date employed from: to:
Hourly Wage: Hours per week:
Your Position & Duties
May we contact this employer for a reference?YesNo

Next most recent employer

Name of Employer
Phone Number
Address including number, street, city, state, zip
Supervisors Name
Reason for leaving
Date employed from: to:
Hourly Wage: Hours per week:
Your Position & Duties
May we contact this employer for a reference?YesNo

Next most recent employer

Name of Employer
Phone Number
Address including number, street, city, state, zip
Supervisors Name
Reason for leaving
Date employed from: to:
Hourly Wage: Hours per week:
Your Position & Duties
May we contact this employer for a reference?YesNo

Resume Upload

(Optional) You may upload a file containing a resume plus any cover letter and references. Note that uploading a resume is not a substitute for filling out this application as completely as possible. File size limit: 125KB. Acceptable formats: Word(.doc), PDF, and TXT.

Notice to all applicants

Please read carefully, initial each paragraph and sign below.

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and 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 omissions 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 hereby authorize CONSERVATION CORPS NORTH BAY to thoroughly investigate my references, work record, education and other matters related to my suitability for employment. I further authorize the references I have given to disclose to CONSERVATION CORPS NORTH BAY 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 CONSERVATION CORPS NORTH BAY, 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.
I understand that nothing contained in the application or conveyed during any interview, which may be granted, or during my employment, if hired, is intended to create an employment contract between CONSERVATION CORPS NORTH BAY and me. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or CONSERVATION CORPS NORTH BAY, and that no promise or representations contrary to the foregoing are binding on CONSERVATION CORPS NORTH BAY.
Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by CONSERVATION CORPS NORTH BAY, I am entitled to copies of any such public records obtained by CONSERVATION CORPS NORTH BAY unless I mark the check box below. If I am not hired as a result of such information, I am entitled to a copy of any such record even though I have checked the box below.
I understand that if chosen for an interview I must provide my Social Security number and date of birth for the purposes of a criminal background check. Further, in the event that I am hired I agree to provide a drivers license for the purpose of a traffic violation review.
I waive receipt of a copy of any public record described in the paragraph above.
I certify by printing my name below that I have read the foregoing, understand the employment requirements, and agree to cooperate in fulfilling them.

Full Name:          Date of Application:
Conservation Corps North Bay is an equal opportunity employer. We consider applicants for all positions without regard to race, religion, gender, marital or veteran status, the presence of a no-job related medical condition or handicap, or any other legally protected status. Qualifications for employment opportunities are based solely upon personal skills, merit and dependability. CONSERVATION CORPS NORTH BAY will ensure that both the spirit and the intent of the laws prohibiting discrimination are fully implemented in all our working relationships.

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