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Coahoma Opportunities, Inc. Employment Application
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Coahoma Opportunities, Inc. Employment Application
An Equal Opportunity Employer (M/F/H/V) – All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic by law.
Once you have completed this application, please upload your resume and transcript(s). If you have to request an official transcript through an electronic transcript website, please have it sent to humanresources@coahomacaa.org
Name
*
First
Last
Physical or Mailing Address
*
Choose One
Physcial Address (Only)
Mailing Address (Only)
Both Physical and Mailing Address
Your Physical Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Your Mailing Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Email
*
Phone
*
Are you eligible to work in the U.S.?
*
Choose One
Yes
No
Are you at least 18 years or older? (If no, you may be required to provide authorization to work.)
*
Choose One
Yes
No
Years Layout Layout
Have you ever been terminated from employment or asked to resign by an employer?
*
Choose One
Yes
No
Please provide company names and details about termination.
*
Next
Employment Desired
Position(s) in which you are applying.
*
Choose One
Bus Driver
Early Head Start Teacher
Family Advocate
Head Start Teacher
Head Start Teacher Assistant
Payroll Accountant
Substitute Teacher Assistant
Teacher Help
Hourly Rate/Salary Desired
When can you start?
Choose One
Immediately upon acceptance of job
2 weeks from job acceptance
Longer than 2 weeks
To be discussed upon acceptance of job
Are you currently employed?
Choose One
Yes
No
If so may we inquire of the present employer?
Choose One
Yes
No
Yes, once job has been offered and accepted.
How did you hear about us?
*
Choose One
Coahoma Opportunities, Inc. website or social media
Walk In
Advertisement at Admin Office or HS/EHS Center
Newspaper Advertisement
Current Employee
Indeed.com
WIN Job Center
Career Fair
If you hear about us through a current employee, please list name(s).
*
Have you ever worked for this company before?
*
Choose One
Yes
No
Next
References
Please provide 3 persons not related to you whom you have known at least 3 years. Please name, email, phone number, and years known for each reference.
Personal Reference 1 First and Last Name
*
First
Last
Personal Reference 1 Email Address
*
Personal Reference 1 Phone Number
*
Personal Reference 1 Years Known
*
Personal Reference 2 First and Last Name
*
First
Last
Personal Reference 2 Email Address
*
Personal Reference 2 Phone Number
*
Personal Reference 2 Years Known
*
Personal Reference 3 First and Last Name
*
First
Last
Personal Reference 3 Email Address
*
Personal Reference 3 Phone Number
*
Personal Reference 3 Years Known
*
Next
Education
Do you have a high school diploma or GED?
*
Choose One
Yes
No
Choose the option that best describes your highest level of education.
*
Choose One
High School Diploma or GED
CDA (Child Development Associate)
Associate's Degree
Bachelor's Degree
Master's Degree
Please list type of CDA received and/or college/university and degree(s) received.
*
Next
Employment History
Include your last seven 7 years of employment history including employer name, start date-end date date (format MM/YYYY), job title, employer hu‐ man resources contact information (physical address, phone number and email address}. If you have never worked a job enter NA and proceed to completing the remainder of the application.
Current or Most Recent Employer Name.
*
Employer Physical Address, City, State.
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Employer Phone Number
*
Employer Email Address
*
Job title and summary of the nature of work performed and job responsibilities.
*
Start Date MM/YYYY
*
End Date MM/YYYY
*
Reason for leaving.
*
Previous Employer 2.
Previous Employer 2 Physical Address, City, State.
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Previous Employer 2 Phone Number
Previous Employer 2 Email Address
Job title and summary of the nature of work performed and job responsibilities.
Start Date MM/YYYY
End Date MM/YYYY
Reason for leaving.
Previous Employer 3
Previous Employer 3 Physical Address, City, State.
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Previous Employer 3 Phone Number
Previous Employer 3 Email Address
Job title and summary of the nature of work performed and job responsibilities.
Start Date MM/YYYY
End Date MM/YYYY
Reason for leaving.
Previous Employer 4
Previous Employer 4 Physical Address, City, State.
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Previous Employer 4 Phone Number
Previous Employer 4 Email Address
Job title and summary of the nature of work performed and job responsibilities.
Start Date MM/YYYY
End Date MM/YYYY
Reason for leaving.
Coahoma Opportunities, Inc is an equal opportunity employer and a Drug/Tobacacco-Free Employer/Non-Profit/501c3 organization. Coahoma Opportunities, Inc. prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristics protected by federal, state, or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
I under that neither the completion of this application nor any other part of my consideration for employment establishes any obligation to Coahoma Opportunities, Inc. to hire me. If I am not, I understand that either Coahoma Opportunities, Inc. or I can terminate my employment at any time for any reason, with or without cause and without prior notice. I understand that no representative of Coahoma Opportunities, Inc. has the authority to make any assurance to the contrary. I understand that if offered the job a thorough criminal, sex offender, and child abuse background check will be administered.
I attest by entering my first name, last name, and last 4 numbers of my SSN below that I have given to Coahoma Opportunities, Inc true and complete information on this application. No requested information has been concealed. I authorize Coahoma Opportunities, Inc. to contact employers and references provided for employment and character reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.
Note: Only complete applications will be remain on file for 6 months. However, if applicants are interested in a future opening, it is your responsibility to contact Coahoma Opportunities, Inc. Human Resources Department via email at humanresources@coahomacaa.org to express interest in the open position before the position posting closes.
I confirm that I understand the above disclaimer.
*
I understand
Next
Voluntary Demographic Informaiton
Completion of this section is
optional.
This information is collected for compliance with Equal Employment Opportunity (EEO) reporting require‐ ments. It will
not
be used in the hiring decision.
Gender
*
Woman
Man
Non-binary/ Third gender
Prefer not to say
Optional: You may self identify as
Race/Ethnicity
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Two or More Races
Prefer not to say
Veteran Status
I am not a veteran
I am a verteran
Prefer not to say
Disability Status
Yes, I have a disability
No, I do not have a disability
Prefer not to say
Next
Equal Employment Opportunity Statement
Coahoma Opportunities, Inc. is an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, sex (including gender identity), national origin, age, disability, veteran status, or any other legally protected status. Completion of the voluntary demographic information above will
not
affect your application or employment with us.
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