Employment

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Aviva Children's Service is an EOE.  No third parties, please.

General Application

* Denotes Required Field

General Employment Form
Full Name *


Street Address & Apartment ( if applicable) *


City and State *


Zip *


Last 4 digits of SS# *


Email *


Home Phone *


Cell Phone


Position Applied For : *


Available for: *




Application Acknowledgement:


I hereby authorize Aviva Children’s Services to verify any information I have provided, and I further authorize any of the named schools, companies or persons listed to provide any information about me contained in their records. My signature also releases Aviva Children’s Services, its officers, agents, and employees from liability for such disclosure. If hired, I understand I will be asked to provide a copy of my most recent motor vehicle record. A request also may be made for a copy of my high school diploma or GED, or university degree if applicable.

If I become employed by Aviva Children’s Services, I understand that it will be necessary for Aviva Children’s Services to have a copy of applicable documents the employer determines are sufficient to prove the applicant's right to work in the U.S.

Aviva Children’s Services is a drug-free workplace. Eligible candidates are required to undergo drug and/or alcohol testing. Circumstances may arise during employment that make it necessary, in the judgment of the employer, for an employee to take random or job-related drug or alcohol examinations, which would be conducted at the employer's expense. Acceptance of employment constitutes the applicant's agreement to submit to such an examination as a condition of continued employment, if requested to do so b y the employer.

I understand that, should I be hired for the position for which I am applying, or any subsequent position, either Aviva Children’s Services or I may terminate the working relationship at any time and for any reason or no reason at all. I understand that no contract may be made orally, regardless of the reliance of the employee to such statements made by any manager at Aviva Children’s Services. I further understand that, if employed, my wages and position may change, but my status as an employee-at-will will never change during my employment. Completion and/or submission of this application does not constitute an offer of employment.

I certify that all of the answers and statements I made on this application or any supplement thereto are true and correct to the best of my knowledge or belief. I understand and agree that any misrepresentation, falsification, or omissions by me in this application may be of sufficient cause for cancellation of the application and/or immediate separation from Aviva Children’s Services if I have since been employed. I agree to immediately notify my employer should I be convicted of a felony or any crime involving dishonesty, breach of trust, federally controlled substance, sexual misconduct, abuse or violence, while my application is pending or during my period of employment if I am hired. I understand that, if hired, I am obligated to meet the terms of current and future Aviva Children’ s Services policies. I further certify that I have not been discharged from employment for misconduct or moral turpitude.



Electronic Signature: *


Date Signed: *

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Employment

Please write a brief statement about your interest in working with Aviva Children’s Services: *


How did you hear about us? *



Please list all current and prior employment for the past ten years, beginning with your most recent employer. Explain any gaps in employment (use additional sheet if necessary). Complete all sections; do not merely write “refer to resume”.

Employer Name *


Street Address *

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City/State/Zip *


Supervisor Name *


Employer Phone Number *


Dates of Employment( From Month/Year To Month/Year) *


Job Titles & Duties: *


Ending Salary: *


Reason for Leaving: *


Employer Name


Street Address

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City/State/Zip


Supervisor Name


Employer Phone Number


Dates of Employment( From Month/Year To Month/Year)


Job Titles & Duties:


Ending Salary:


Reason for Leaving:


Employer Name


Street Address

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City/State/Zip


Supervisor Name


Employer Phone Number


Job Titles & Duties:


Dates of Employment( From Month/Year To Month/Year)


Ending Salary:


Reason for Leaving:


Employer Name


Street Address

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City/State/Zip


Supervisor Name


Employer Phone Number


Dates of Employment( From Month/Year To Month/Year)


Job Titles & Duties:


Ending Salary:


Reason for Leaving:


Attach additional sheet if necessary




Volunteer History

Agency Name


Street Address


City/State/Zip


Supervisor Name


Phone Number


Dates( from Month/Year To Month/Year


Position/Responsibilities


Reason for Leaving


Agency Name


Street Address


City/State/Zip


Supervisor Name


Phone Number


Dates( from Month/Year To Month/Year


Position/Responsibilities


Reason for Leaving




Education History




High School History

School Name


Major/Minor


# of Years Completed


Type of Degree

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Graduate?



College History

School Name


Major/Minor


# of Years Completed


Type of Degree

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Graduate?



Vocational History

School Name


Major/Minor


# of Years Completed


Type of Degree

Invalid Input
Graduate?



College (graduate)

School Name


What is/was your GPA in your major field of study?


Major/Minor


# of Years Completed


Type of Degree

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Graduate?


What is/ was your GPA in your major field of study (undergraduate)?


Overall GPA?


What is/was your GPA in your major field of study (graduate)?


Overall GPA?


List classes you have completed that relate to Social Work, Child Development and Communication/ Writing:


What are your educational and career goals?


Summarize special skills and qualifications acquired from employment or other experiences that may qualify you for work with Aviva Children’s Services, including second languages (spoken fluently):


Please elaborate on any experience you have had with children (baby-sitting, church groups, tutoring, etc.):




Miscellaneous Information

Have you ever been convicted of or plead no contest to a felony or misdemeanor (other than a traffic violation)? *


If yes, please elaborate:


To be employed by Aviva Children’s Services, you are required to undergo a criminal background check for a fingerprint clearance card (expense paid by the agency). Are you willing to do this? *



Refernces


List three people we can contact for references. Professional and/or educational references are preferred. Only one of these references may be a relative. Phone numbers must be included.

Name


Address *


Telephone *


Relationship to You *

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Name


Address


Telephone


Relationship to You

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Name


Address


Telephone


Relationship to You

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