Step 1: Position Information

Position applying for*

Available Start Date (mm/dd/yyyy)*

Are you available to work?*

Full-Time Part-Time

Number of hours available per week?

Step 2: Personal Data

Full Name (First – Middle Initial – Last)*

Street Address*


City*


State*


Zip*


Email Address


Cell Phone*


Home Phone*


Best time to contact you


Desired salary range

Step 3: Employment Questions

1. Are you 18 years or older?*
Yes No

2. (Only answer if applying for a Bus Driver position) Are you 21 years of age or older?
Yes No

3. Are you legally eligible to be employed in the United States? (Proof of identity and eligibility will be required upon employment) *
Yes No

4. Will you now or in the future require sponsorship for employment visa status (e.g. H-1B)? *
Yes No

5. Do you possess a valid driver's license? *
Yes No

6. Have you previously applied for a position with SCCAP? *
Yes No
If yes, list position(s) and dates.


7. Have you worked for SCCAP before? *
Yes No
If yes, list position and dates.


8. Do you have relatives or in-laws working at SCCAP or serving in any capacity on our Board of Directors of this agency? *
Yes No
If yes, list name and relationship.


9. Do you have commitments to another employer that might affect your availability for employment with SCCAP? *
Yes No

10. Are you on a layoff and subject to recall at another employer? *
Yes No

11. In the last 5 years have you ever been discharged or forced to resign from any job? *
Yes No
If yes, please explain.


12. Have you ever been convicted of a felony or misdemeanor? * This does not include minor traffic violations.
Yes No
If yes, please explain: Note: a yes answer does not automatically disqualify you from employment since the nature of the offense, date, and type of job for which you are applying for will be considered.


13. Have you ever been charged with a crime that has not yet resulted in a plea of guilty, court trial, or dropping of the charge? *
Yes No

14. If hired, would you be able to work normal days and hours required for the position? *
Yes No

15. Can you travel if a job requires it? *
Yes No

Step 4: Educational Information

Step 6: References

List 3 professional references. (References should only be professional and not related to you.)

Upload a Résumé

Select résumé/CV file from your PC:

Supported file types(.pdf, .txt, .rtf, .doc, .docx, .html)

Step 8: Authorization

PLEASE READ CAREFULLY AND INITIAL (FIRST AND LAST INITIAL) EACH PARAGRAPH BEFORE SIGNING

 By signature and initials, I promise that the information provided in this employment application (and accompanying resume, if any) is true and complete, and I understand that any false information, misrepresentation, or material omissions may disqualify me from further consideration for employment, and may be justification for my dismissal from employment by SCCAP if discovered at a later date. I agree to immediately notify SCCAP if I should be convicted of a felony, or any crime involving dishonesty or a breach of trust while my job application is pending or during my period of employment, if hired.

 I authorize any person, school, current employer (except as previously noted), past employers, government or investigative agencies, and other organizations that may be named in this application form (and accompanying resume, if any) to provide the company with relevant information and opinion that may be useful to SCCAP in making a hiring decision, and I release such persons and organizations from any legal liability in making such statements.

 I understand that an employer that discloses information about a current or former employee is immune from civil liability for the disclosure and the consequences proximately caused by the disclosure unless it is proven by a preponderance of the evidence that the information disclosed was known to be false at the time the disclosure was made. (Ind. Code 22-5-3-1-b)

 I authorize SCCAP to obtain the following information in connection with my application for employment, or, if hired, at any time during my employment: criminal and/or motor vehicle records, employment records, or educational records. I acknowledge that SCCAP has informed me that it may make use of this information in evaluating my application for employment, and in SCCAP decisions regarding hiring, compensation, promotion, reassignment, retention, and other terms of my employment at SCCAP. I authorize SCCAP to make use of the above-referenced information and waive any claim against SCCAP for using such information in good faith.

 I understand that if employed and my employment is terminated by SCCAP for dishonesty, breech of trust, or any criminal acts, the authorities may be notified and I may be criminally prosecuted.

 I understand that this application does not, by itself, create a contract of employment. I understand and agree that, if hired, my employment is no definite period of time, and may, regardless of the date of payment of my wages or salary, be terminated at any time.

Applicant Electronic Signature


Date (mm/dd/yyyy)