Employment Application Step 1 of 3 - Step One 0% In what department are you interested?*ICF-IID Group HomesSupported EmploymentAdministrationEmployee Information First Name*Middle NameLast Name*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Alternate PhoneEmail* Have you ever been previously employed with CFGH or CFVS?*YesNoIf yes, what dates? From:Please enter a number from 1990 to 2030.To:Please enter a number from 1990 to 2030.Are you related to any employees of CFGH or CFVS?*YesNoIf yes, please enter name(s):Are you a United States citizen?*YesNoHave you ever been convicted of a criminal offense?*YesNoIf no, are you authorized to work in the US?YesNoIf yes, please explain:Date you can begin work?* Date Format: MM slash DD slash YYYY Expected pay rate?*Days you are available to work?* Select All Sunday Monday Tuesday Wednesday Thursday Friday Saturday Times you are available to work?*e.g. 7a-3p, 3p-11p, 9a-5p, etc. EducationHigh School Name*Address* Street Address Address Line 2 City State / Province / Region Dates attended? From:* Date Format: MM slash DD slash YYYY To:* Date Format: MM slash DD slash YYYY Did you graduate?YesNoDiploma Type*ChooseCertificateVocationalGeneralHonorsOtherCollege NameAddress Street Address Address Line 2 City State / Province / Region Dates attended? From: Date Format: MM slash DD slash YYYY To: Date Format: MM slash DD slash YYYY Major or course of studyDid you graduate?YesNoNameAddress Street Address Address Line 2 City State / Province / Region Dates attended? From: Date Format: MM slash DD slash YYYY To: Date Format: MM slash DD slash YYYY Major or course of studyDid you graduate?YesNo Previous EmploymentName*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Phone*Job Title*Supervisor's Name*Starting Salary*Ending Salary*Primary Responsibilities*Dates worked? From:* Date Format: MM slash DD slash YYYY To:* Date Format: MM slash DD slash YYYY May we contact your previous employer?*YesNOReason(s) for leaving*NameAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State PhoneJob TitleSupervisor's NameStarting SalaryEnding SalaryPrimary ResponsibilitiesDates worked? From: Date Format: MM slash DD slash YYYY To: Date Format: MM slash DD slash YYYY May we contact your previous employer?YesNOReason(s) for leavingNameAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State PhoneJob TitleSupervisor's NameStarting SalaryEnding SalaryPrimary ResponsibilitiesDates worked? From: Date Format: MM slash DD slash YYYY To: Date Format: MM slash DD slash YYYY May we contact your previous employer?YesNOReason(s) for leavingUpload Resume HereAccepted file types: docx, pdf, doc.Only .docx, .doc, and .pdf files less than 1MB allowedDisclaimer By clicking the submit button below, I certify that my answers are true and complete to the best of my knowledge. If this application and subsequent interview leads to employment, I understand that any false or misleading information communicated to Cape Fear Group Homes, Inc. may result in termination of employment.Click the checkbox below.
