New job application-TEST

If you would prefer to fill out a printable copy of our employment application, contact us.

CPRF is an equal opportunity employer.

Upload cover letter & resume (optional). Please name your file after your own name, ex: john_smith.doc or johnsmith.pdf.

Drop files here or

Max. file size: 10 MB.

Name*

First Last

Phone*

Email*

Address*

Street Address City State ZIP Code

Position Applying For:*

Date Available To Begin Work:*

Seeking:

Part-Time Employment
Full-Time Employment

Availability:

Mornings
Afternoons
Evenings

Are you currently employed?

Yes
No

If yes, may we contact your current employer?

Yes
No

Work Experience

Please list your previous work experience below, starting with your most recent/current employer.

Company Name

Dates Employed Job Title Supervisor Name Supervisor Phone Current Rate of Pay

Position Responsibilities:

Reason For Leaving:

May we contact this employer?

Yes
No

Company Name

Dates Employed Job Title Supervisor Name Supervisor Phone

Position Responsibilities:

Reason For Leaving:

May we contact this employer?

Yes
No

Company Name

Dates Employed Job Title Supervisor Name Supervisor Phone

Position Responsibilities:

Reason For Leaving:

May we contact this employer?

Yes
No

Please explain why you would like to work at CPRF:*

Education

High School

High School Name City State Years Completed

Do you have a H.S. Diploma or GED?

Yes
No

College (Undergraduate)

College/University Name City State Years Completed Graduation Date

Major or Concentration

College (Graduate/Additional)

College/University Name City State Years Completed Graduation Date

Major or Concentration

Professional References

Please list three professional references who are not related to you.

Name Phone Email Relationship

Conviction Record

Have you ever been convicted of a crime other than a minor traffic offense?*

Yes
No

If yes, please explain.

(An affirmative response will not necessarily disqualify you from employment.)

Permission To Work

Are you legally authorized to work in the United States?*

Yes
No

Reference Release / Applicant Statement

Please read and electronically consent to the statement below.*

By checking this box and providing my initials below, I am agreeing to the following statement:

CEREBRAL PALSY RESEARCH FOUNDATION OF KANSAS, INC.
APPLICANT ACKNOWLEDGMENT AND RELEASE TO
OBTAIN REFERENCE INFORMATION

READ CAREFULLY BEFORE SIGNING

In signing and submitting this application for employment to you, Cerebral Palsy Research Foundation of Kansas, Inc., (CPRF), I clearly acknowledge and agree that: (1) the information contained in my application for employment is correct and complete to the best of my knowledge and understand that any omission, misrepresentation or falsification of information made therein or in any interviews are grounds for refusal to employ me or my dismissal if I am employed; (2) I authorize the references, schools, and current and past employers I have identified to give the Company any and all information concerning my previous employment and any information they may have, personal or otherwise, and I release all parties from all liability for any damage or claim that may result from furnishing the same to CPRF; (3) if I am employed, I agree to abide by the rules, regulations, and policies of CPRF, and my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either CPRF or myself; and (4) I understand that no representative of CPRF, other than the President/CEO, has any authority to enter into any agreement for employment for any specified period of time, or make any agreement contrary to the foregoing.

Applicant's Initials*

Today's Date*

New job application-TEST

Employment Application

Work Experience

Education

Professional References

Conviction Record

Permission To Work

Reference Release / Applicant Statement