Personal Information First Name (required) Last Name (required) Middle Initial Address (required) City (required) State (required) Zip (required) Home Phone Number (required) Work Phone Number Cell/Mobile Phone Number Emergency Contact and Phone Number(required) Eligibility Requirements Are you at least 18 years old? (required) Yes No If not, do you have a valid work permit? Yes No Do you have a valid Maryland Driver's License? (required) Yes No Do you have a legal right to work in the United States? (required) Yes No If hired, it will be necessary for you to submit documentation of your identity and right to work in the United States. Creative Options, Inc. participates in E-Verify, a service of the Department of Homeland Security and the Social Security Administration. Information provided by employees on the Form I-9 will be used to confirm work authorization. Have you ever been convicted of a crime other than a minor traffic violation? (required) Yes No Are you currently under charges for an offense? (required) Yes No If you answered "Yes" to any of the questions above, please explain below. Please note that a conviction record will not necessarily prevent employment at Creative Options, Inc. Position Request Position Desired: Salary Desired: Date Available to Start: Shift Desired: Day Evening Awake Over Night Which shifts are you willing to work? Full-Time Part-Time Temporary/Substitute Are you available to work weekends? Every Every Other Some None Education Please include all of your education below: High School Location Highest Grade Completed Degree or Diploma College Location Highest Grade Completed Degree or Diploma Graduate Work Location Highest Grade Completed Degree or Diploma Other Location Highest Grade Completed Degree or Diploma Professional Membership Membership in Professional Organizations It is optional to include those which may disclose your race, color, creed, or national origin, age, sex, political or religious opinion or affiliation, disability, military status, ancestry, or sexual preference. Professional Licenses & Certification Include number, date issued, state of issuance, and renewal date. Other Skills and Qualifications Typing - Words Per Minute Do you have experience with these software applications? Excel Word Outlook PowerPoint Other Software Languages List those in which you are fluent. Other Skills List other skills, qualifications, accomplishments, hobbies, awards, community activities which are relevant to the position for which you are applying. It is optional to disclose those organizations that would reveal race, color, creed, or national origin, age, sex, political or religious opinion or affiliation, disability, military status, ancestry or sexual preference. Military Complete this section only if you have served in the Armed Forces Branch of Service From To Rank at Discharge Awards and Commendations Describe duties any any special training Employment History List below your employment experience. Begin with the most recent employment including all jobs, volunteer work, and school attendance for at least the past seven years. If additional space is needed, please also attach your resume at the end of the application. May we contact your present employer? Yes No Company Name Telephone Number Company Address (including zip code) Dates of Employment Name and Title of Supervisor Starting Pay Ending Pay Job Title Major Duties Reason for Leaving Add Additional Work History Company Name Telephone Number Company Address (including zip code) Dates of Employment Name and Title of Supervisor Starting Pay Ending Pay Job Title Major Duties Reason for Leaving Add Additional Work History Company Name Telephone Number Company Address (including zip code) Dates of Employment Name and Title of Supervisor Starting Pay Ending Pay Job Title Major Duties Reason for Leaving Add Additional Work History Company Name Telephone Number Company Address (including zip code) Dates of Employment Name and Title of Supervisor Starting Pay Ending Pay Job Title Major Duties Reason for Leaving References Please list individuals who are fmailiar with your character, knowledge, professional skills, and work abilities. Do not include family members. Name Complete Mailing Address Telephone Number Occupation Were you referred by an employee of Creative Options, Inc? Yes No If yes, state the name of the employee List the names and relationships of all relatives who work for Creative Options, Inc. Acknowledgements Creative Options, Inc. is an equal opportunity employer. We do not discriminate on the basis of race, color, creed or national origin, age, sex, political or religious opinion or affiliation, military status, ancestry, sexual preference, or physical or mental disability unrelated to the job in question. This policy applies to every aspect of the employment relationship. Please read before signing I have read the statements of this application and also certify that the information presented herein is complete and accurate. I understand that false statements and/or material ommissions on this application may be considered cause for rejection of this application or for termination of employment. I hereby authorize Creative Options, Inc. to conduct work history, reference, police record and motor vehicle inquiries as it deems appropriate. I release all parties from liability for any damage that may result from furnishing information and opinions about me to representatives of Creative Options, Inc. I release and indemnify Creative Options, Inc. and its representatives against any liability that arises out of such investigation. Nothing contained in this employment application or in granting an interview is intended to create an employment contract between Creative Options, Inc. and myself for either employment or for proving of any benefit. No promises regarding employment have been made to me. If any employment relationship is established, I understand that I have the right to terminate my employment at any time and that Creative Options, Inc. retains a similar right. I consent to taking drug/alcohol tests, necessary physical examinations, and pre-employment tests and I understand that my employment may be contingent upon the release of these examination(s). If offered employment by Creative Options, Inc. I understand that I may have to submit to the same or similar tests and continued employment may be contingent on the results. My signature below indicates that I have read, understand, and agree to the above statements. My name typed below will be used as my electronic signature. Your Email (required) Subject Your Message
