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Employment Application

Your Information
Position you are applying for*:
At which branch are you applying? (cmd or ctrl click to select multiple):
First Name*:
Last Name*:
Phone (Home)*:
Email*:
Address*:
Apt/Suite #:
City*:
State*:
ZIP Code*:
How were you referred to the Clayton County Community Service Authority? (ctrl or cmd + click to select multiple answers):
Employee referred by:
Have you ever been employed by the Clayton County Community Service Authority?*:
If yes enter dates:
Have you previously worked for the Clayton County Community Service Authority?*:
If yes enter date(s) and location:
Are you legally eligible for employment in this country?*:
Have you failed to be re-employed, ever been involuntarily discharged or asked to resign a position?*:
If yes please provide date(s) and circumstances.:
Have you ever been convicted of a crime?:
If yes provide date(s) and circumstances.* Conviction will NOT necessarily be a bar to employment. Each instance and explanation will be considered in relation to the position for which you are applying:
Educational Background*
Please include school(s) attended, degree/diploma earned and field of study (if applicable):
Employment History*
Please list employer name, address, phone number, job title, immediate supervisor, and dates employed:
Certifications
Please list certifications, special accomplishments, special trainings, etc.:
References*
Please list name and telephone number of 3 references. Only 1 reference can be a personal reference.:
Attach Resume File:

What is your race/ethnicity? Please mark the one box that describes the race/ethnicity category with which you primarily identify.
These questions are processed and maintained separately from your personnel file and is not used to make decisions about the terms and conditions of employment. Completion of this form is optional and voluntary. We appreciate your assistance.

Hispanic or Latino: a person of Cuban, Mexican, Chicano, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
White: a person having origins in any of the original peoples of Europe, the Middle East, or North Africa
Black or African American: a person having origins in any of the black racial groups of Africa.
Asian: a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan,the Philippine Islands, Thailand, and Vietnam.
Native Hawaiian or Other Pacific Islander: a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
American Indian or Alaska Native: a person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
Two or More Races: a person who primarily identifies with two or more of the above race/ethnicity categories.

AN EQUAL OPPORTUNITY EMPLOYER

The Clayton County Community Service Authority is an equal opportunity employer and affords equal opportunity to all applicants for all positions without regard to race, color, religion, gender, national origin, age, disability, veteran status or any other status protected under local, state or federal laws.

By checking this box you are confirming you have read, understand, and agree to the above.
By checking this box you are confirming you have read, understand, and agree to the terms and conditions.: