We consider applicants for all positions without regard to race, color, religion, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

Position applying for:       Date you are available to start:
How did you learn about us?
Name & Address
Last Name
First Name
Middle Name
Zip Code
Home Phone
Work Phone
Cell/ Other Phone
Email Address
If you are under 18 years old, can you provide required proof of your eligibility to work? Yes No
Have you ever been employed by the Center for Alcohol & Drug Treatment before? Yes No
If Yes, provide last employment dates:
Are you currently employed? Yes No
May we contact your employer? Yes No
Are you prevented from lawfully becoming employed in this country because of VISA or Immigration status? (Proof of citizenship will be required upon employment) Yes No
On what date would you be available to work?
Are you available to work: Full Time Part Time Shift Work Temporary
Are you currently on a laid off status and subject to recall? Yes No
Do you have dependable means of transportation to and from work? Yes No
If yes, please explain:
Have you experienced any problems with the use of alcohol or drugs in the past two years? Yes No
If yes, please explain:
DO NOT answer these questions unless you have been informed of the requirements of the job you are applying for.    
Are you capable of performing, in a reasonable manner, the activities involved in the job you applied for? Yes No
Do you meet the requirements for the job which you applied? Yes No
  Name of School
City, State
Course of Study Years Completed Diploma/Degree
High School
Undergraduate College
Graduate Professional
Other (specify)
Do you have a professional license to the position you are applying for? Yes No
If yes, what license:
Employment Experience: start with your present or last job; include any job-related military experience and volunteer work. You may exclude any organization that indicates race, color, religion, gender, national origin, or other protected status.
Employer Dates Employed Work Performed
Name Address Phone Number

Supporting File #1:
Supporting File #2:

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize the Center for Alcohol & Drug Treatment to investigate all statements contained in this application as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “At Will” nature, which means that the employee may resign at any time and the employer may discharge the employee at any time, with or without cause. It is further understood that this “At Will” employment relationship may not be changed by any written document or by conduct, unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand also that I am required to abide by all rules and regulations of the employer.

Applicant Signature Date
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