Employment Application

NOTE: Once you start the application you must fill it out thoroughly. You cannot save the application and come back to it later. Apologies for the inconvenience.

Step 1 of 10

Read Before Applying

The CAPMC is an equal opportunity employer. CAPMC provides equal employment opportunity to all persons regardless of race, national origin, religion or creed (including religious dress and grooming practices), color, ancestry, physical or disability (perceived disability, requesting accommodation for disability or religious beliefs, medical condition (including HIV and AIDS), genetic characteristics or information, marital status, registered domestic partner status, sex (including pregnancy, perceived pregnancy, childbirth, breastfeeding and medical conditions related to pregnancy, childbirth or breast feeding), sexual orientation, gender, gender identity, gender expression, transgender, transitioning, sex stereotyping, reproductive decision-making, age, citizenship, military/service member status and veteran status, as well as any other category protected by federal, state or local law or ordinance or regulation.

Instructions

Read position announcement thoroughly and understand all the minimum qualifications.

Answer all questions by writing clearly or typing in black/blue ink. Provide enough details to allow for full review and consideration. If an answer does not apply to you, write N/A.

Completely fill out the application and sign it.

Use a separate application when applying for more than one position.

Inquiry may be made of your former and current employers or schools regarding your performance records. Please provide the name and phone number of each contact on your application.

Please contact the Human Resources Office if you change your address or telephone number.

If you need any accommodation in the application or the testing process pursuant to the Americans with Disabilities Act (ADA) or the California Fair Employment and Housing Act (FEHA), please call the Human Resources Office at (559) 673-9173.

Education

Note: The failure to have a High School Diploma or receiving a GED is not necessarily disqualifying unless the diploma or GED is directly realted to the ability to perform the job (or is a government or regulatory requirement) for which the applicant is applying.

Do you have a High School Diploma?(Required)

Yes

If Yes, Name and Address of the school(Required)

Did you receive a GED?(Required)

Yes

Technical/ Vocational / Business School

Name of the School

Address of the School

Street Address Address Line 2 City State ZIP Code

Course of Study:

Certification/Degree Received:

Name of the School

Address of the School

Street Address Address Line 2 City State ZIP Code

Course of Study:

Certification/Degree Received:

University/College

Name of the School

Address of the School

Street Address Address Line 2 City State ZIP Code

Major/Course of Study:

Units Completed:

Academic Session

Did you graduate?

Yes

Date Degree was conferred:

Did you take any Early Child Development Units?

Yes

Units Completed:

Academic Session

Employment History

List most recent experience first. Please give enough information to allow for review and evaluation of your work experience and abilities. Include paid or unpaid, full or part time, temporary. List each job title even if employed by the same employer.

Experience 1

From Date(Required)

To Date(Required)

Title/Job Classification(Required)

Company/Organization Name(Required)

Hours Per Week(Required)

Total Worked(Required)

Supervisor Name(Required)

First Last

Supervisor Phone Number(Required)

List Duties Performed(Required)

Reason for Leaving(Required)

Experience 2

From Date(Required)

To Date:(Required)

Title/Job Classification(Required)

Company/Organization Name(Required)

Hours Per Week(Required)

Total Worked(Required)

Supervisor Name(Required)

First Last

Supervisor Phone Number(Required)

List Duties Performed(Required)

Reason for Leaving(Required)

References

Please list below three (3) people who do not work at CAPMC and not related to you who have knowledge of your work performance within the last three (3) years.

Name(Required)

First Last

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Occupation(Required)

No. of Years Acquainted(Required)

Name

First Last

Phone

Address

Street Address Address Line 2 City State ZIP Code

Occupation

No. of Years Acquainted

Name

First Last

Phone

Address

Street Address Address Line 2 City State ZIP Code

Occupation

No. of Years Acquainted

Statement of use of Criminal Convition Records

Once CAPMC makes a conditional offer of employment to an applicant, it may ask about and consider the applicant’s conviction records. Records such as arrest records that did not lead to conviction, referrals to participation in pretrial or post-trial diversion programs, non-felony convictions for marijuana possession that are two or more years old, and convictions that have been judicially sealed, dismissed, expunged, statutorily eradicated, or court dispositions governed by a juvenile court are generally off limits (except where may be required to obtain a Department of Social Services or other clearance required by programs such as Head Start) at any point in the hiring process and will not be considered. Before denying employment based on a conviction record, CAPMC will conduct an individualized assessment as to whether the conviction has a “direct and adverse relationship” with the specific job duties of the position being applied for by the applicant. Accordingly, CAPMC will consider the following:

The nature and severity of the offense,

How long it has been since the applicant committed the offense and served his or her sentence, and

The nature of the job the applicant is applying for.

Notice and an Opportunity to Respond

If, after completing this inquiry, CAPMC decides not to hire the applicant; CAPMC will provide the applicant with written notice of its decision. This will:

Specify the conviction that was the basis for the decision

Provide a copy of the conviction history report, if CAPMC has one, and

Explain the applicant’s right to respond with favorable evidence by a certain deadline.

CAPMC will provide the applicant five business days to challenge the accuracy of the information obtained by CAPMC or to provide mitigating evidence that lessens the impact of the conviction. Example, the applicant might submit evidence of completion of a drug rehabilitation program or the applicant’s efforts to make amends for the crime. If the applicant notifies CAPMC within five business days that he or she is taking steps to gather evidence, CAPMC will provide an additional five business days to respond to the notice.

Notice of the Final Decision

CAPMC will consider any information provided by the applicant before making a final decision. If the final decision is to deny employment, CAPMC will provide written notice of this decision to the applicant. There is no appeal or grievance process to challenging this decision. All applicants who believe that CAPMC acted unlawfully in making any employment decision based in whole or in part on the applicant’s criminal conviction history has the right to file a complaint with the California Department of Fair Employment & Housing. Please note that CAPMC will never consider the following information in reviewing an applicant’s criminal conviction history once a conditional offer of employment is made or at any time during the hiring process:

Arrest records. CAPMC may not ask an applicant about prior arrests that did not lead to convictions or seek or use records related to such arrests. CAPMC may ask applicants about arrests that did lead to conviction and arrests for which the applicant is awaiting trial (for example, because the applicant is out on bail or has been released on his or her own recognizance pending trial).

Diversion programs. CAPMC may not ask about an applicant's referral to or participation in a pretrial or post-trial diversion program.

Sealed records. CAPMC may not ask about convictions that have been sealed, expunged, or statutorily eradicated.

Certain marijuana offenses. CAPMC may not ask about non-felony convictions for marijuana possession that are more than two years old.

Juvenile records. CAPMC may not ask applicants about juvenile records relating to arrest, detention, processing, or adjudication while the applicant was subject to the juvenile court system. California does not consider juvenile court decisions to be “convictions” that employers could otherwise inquire about.

Certification

PLEASE READ CAREFULLY, CHECK THE BOX OF EACH PARAGRAPH AND SUBMIT BELOW. (IF THERE IS ANY PART OF THIS PAGE YOU DO NOT UNDERSTAND, PLEASE CONTACT THE HUMAN RESOURCES OFFICE ABOUT IT BEFORE SIGNING).

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 and/or reviewed all information contained in this this application and verified its accuracy. I understand that any error, omission or misstatement on this application or on any documents used to secure employment shall be grounds for rejection of this application or for immediate discharge if the error, omission or misstatement is discovered after if I am employed, regardless of the time elapsed before discovery.

I hereby authorize CAPMC to thoroughly investigate my references, work records, education and other matters related to my suitability for employment and, further, authorize my current and former employers to disclose to the company any and all letters, reports and other information pertaining to my employment with them, without giving me prior notice of such disclosure. In addition, I hereby release CAPMC, my current and 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 if offered employment, the offer may be contingent upon my passing a preemployment alcohol and drug screen compliant with applicable state and federal law, appropriate fingerprint clearance and reference checks, pre-employment physical, immunization requirement, and TB test as may be required for the position applied for, especially Head Start positions. By signing this application, I voluntarily agree to submit to a pre-employment alcohol/drug screen and preemployment physical following receipt of a conditional offer of employment but before actually commencing employment. I understand that failure to pass the alcohol/drug screen and/or physical will result in withdrawal of the employment offer.

I understand that nothing contained in the application or conveyed to me during any interview that may be granted is intended to create an employment contract, express or implied, between CAPMC and me. In addition, I understand and agree that if I am employed, during my initial probationary period of employment, my employment relationship with CAPMC is strictly voluntary and at-will meaning that my employment may be terminated at any time, with or cause, without or without notice at any time for any lawful reason, or no reason at all at the option of either myself or CAPMC. No promises or representations contrary to the foregoing are binding on CAPMC unless made in writing and signed by the Executive Director of CAPMC.

I understand and agree that any future changes in my title, duties, compensation, working conditions, and/or CAPMC benefits, policies and procedures will not alter any existing at-will relationship except by a written agreement signed by the Executive Director of CAPMC expressly altering that relationship.

I understand that if offered employment, I will, as a condition of employment, be required to submit proof of my identity and legal right to work in the United States during any period of employment with CAPMC.

I understand that to the extent the position for which I am hired requires me to drive in the course and scope of my employment, I will be required to possess a current and valid California driver's license and provide a copy of my license, official driving record and proof of insurance with the minimum California-required limits of insurance. I also understand that any offer of employment in a position which requires me to drive in the course and scope of my employment will be contingent on my ability to be covered by CAPMC auto insurance.

I understand that if provided a conditional offer of employment, the nature of the position may be contingent upon me passing a criminal background check. CAPMC may ask about and consider an applicant’s criminal conviction records once an offer of employment is made in accordance with its criminal background check policy. Please see Statement of Use of Criminal Conviction Records provided during the application process.

Name(Required)

First Last

Date(Required)