Employment Application

Personal Information

Date

Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Are you related to anyone working at MAPS, Inc.?(Required)

Yes

No

If yes, please indicate the staff member's name and your relationship to them.

Background Data

Can you submit verification of your legal right to work in the US?(Required)

Yes

No

Are you 18 years of age or older?(Required)

Yes

No

Are you able to perform the essential functions of the job for which you are applying, without a reasonable accomodation?(Required)

Yes

No

Employment History

Please provide the following information for your past four (4) employers, assignments or volunteer activities, starting with your most recent.

Employer Name(Required)

Start Date(Required)

End Date(Required)

Job Title(Required)

Employer Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Supervisor Name(Required)

First Last

Job Duties/Responsibilities(Required)

Reason for Leaving:(Required)

Employer Name(Required)

Start Date(Required)

End Date(Required)

Job Title(Required)

Employer Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Supervisor Name(Required)

First Last

Job Duties/Responsibilities(Required)

Reason for Leaving:(Required)

Employer Name(Required)

Start Date(Required)

End Date(Required)

Job Title(Required)

Employer Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Supervisor Name(Required)

First Last

Job Duties/Responsibilities(Required)

Reason for Leaving:(Required)

Employer Name(Required)

Start Date(Required)

End Date(Required)

Job Title(Required)

Employer Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Supervisor Name(Required)

First Last

Job Duties/Responsibilities(Required)

Reason for Leaving:(Required)

Professional References

Please list four (4) with at least three (3) being professional references who can discuss your current or past work performance.

Name(Required)

First Last

Phone(Required)

Email(Required)

Organization and Position(Required)

Relationship(Required)

# of years known(Required)

Name(Required)

First Last

Phone(Required)

Email(Required)

Organization and Position(Required)

Relationship(Required)

# of years known(Required)

Name(Required)

First Last

Phone(Required)

Email(Required)

Organization and Position(Required)

Relationship(Required)

# of years known(Required)

Name(Required)

First Last

Phone(Required)

Email(Required)

Organization and Position(Required)

Relationship(Required)

# of years known(Required)

Basic Expectations at MAPS Inc.

Overtly supports and acts in accordance with the program's mission. Demonstrates planning and preparation for sessions. Develops and maintains an inviting environment and atmosphere. Shows evidence of professional standards of personal presentation, punctuality, professional courtesy, and discretion. Maintains professional credentials and/or certifications.

Acknowledgement

I understand and acknowledge the following:

1. If I am offered employment, as a condition of employment, I will be required within three (3) days of beginning work to submit proof of my identity and legal right to work in the United States. 
2. I hereby certify that all of the information set forth in this application and any attached resume is true, complete, and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I agree that any omission, misrepresentation, falsification, or misstatement of material facts or information on this application or related document may result in the rejection of this application or related document may result in the rejection of this application or my immediate discharge if I am employed. 
3. I authorize any of the persons or organizations referenced in this application to provide MAPS Inc. with any and all information that they may possess concerning my previous employment, education or experience. I authorize MAPS Inc. to request and receive such information. I also understand that, in conjunction with this application, I will be asked to complete and sign a "Background Screening Consent" form. 
4. I understand and agree that, if I am offered a position, it will be offered on condition that my employment shall be at-will, as defined by the law and for no definite period, and that my employment may be terminated at any time, with or without cause and with or without prior notice, by myself, or MAPS Inc.; or, if I am offered an employment contract, the terms and conditions of my employment will be governed by the terms of the employment contract. 
5. I have read, understand, and accept the Basic Expectations. 
6. I have read and understand everything in this application.

Name(Required)

First Last

Date(Required)

Signature(Required)

Resume(Required)

Drop files here or

Max. file size: 512 MB.

Cover Letter or Other Attachments

Drop files here or

Max. file size: 512 MB.