CASEWV Online Application Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone (###) ### #### Position Appling for: Teacher, Bus Driver, Home Health Aide, ect Employment Desired: Full-Time Part-Time Full-Time or Part-Time How did you hear about the position? Social Media A Friend From a CASEWV Employee CASEWV.org A Flyer Highest Level of Education Completed High School College Business or Trade School Professional School Name of High School Last Attended/Graduated Date of High School Graduation MM DD YYYY College/Trade School Name Number of Years Attended 1 2 3 4 5 6 7 8 Major/Degree Date of College/Trade/Business School Graduation MM DD YYYY Have you ever been convicted of a crime? * Yes No If Yes, explain the number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation. I understand that after Community Action of Southern Eastern West Virginia receives my criminal investigation background check, that is there are findings it can be grounds of immediate dismissal. Yes No Work Experience Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. May we contact your prior employer(s)? Yes No Prior Employer #1 Employer #1 Address Address 1 Address 2 City State/Province Zip/Postal Code Country Prior Employer #1 Phone Number (###) ### #### Prior Employer #1 Supervisor First Name Last Name Employer #1 Hire Date MM DD YYYY Employer #1 Final Day of Employment MM DD YYYY Employer #1 Pay of Salary Reason for Leaving Employer #1 Prior Employer #2 Employer #2 Address Address 1 Address 2 City State/Province Zip/Postal Code Country Prior Employer #2 Phone Number (###) ### #### Prior Employer #2 Supervisor First Name Last Name Employer #2 Hire Date MM DD YYYY Employer #2 Final Day of Employment MM DD YYYY Employer #2 Pay of Salary Reason for Leaving Employer #2 Prior Employer #3 Employer #3 Address Address 1 Address 2 City State/Province Zip/Postal Code Country Prior Employer #3 Phone Number (###) ### #### Prior Employer #3 Supervisor First Name Last Name Employer #3 Hire Date MM DD YYYY Employer #3 Final Day of Employment MM DD YYYY Employer #3 Pay of Salary Reason for Leaving Employer #3 Prior Employer #4 Employer #4 Address Address 1 Address 2 City State/Province Zip/Postal Code Country Prior Employer #4 Phone Number (###) ### #### Prior Employer #4 Supervisor First Name Last Name Employer #4 Hire Date MM DD YYYY Employer #4 Final Day of Employment MM DD YYYY Employer #4 Pay of Salary Reason for Leaving Employer #3 Additional References Please list two references other than relatives or previous employers Reference #1 First Name Last Name Reference #1 Job Title Reference #1 Address Address 1 Address 2 City State/Province Zip/Postal Code Country Reference #1 Phone (###) ### #### Reference #1 Email Address Reference #2 First Name Last Name Reference #2 Job Title Reference #2 Address Address 1 Address 2 City State/Province Zip/Postal Code Country Reference #2 Phone (###) ### #### Reference #2 Email Address For Bus Drivers and Meal Carriers Only Do you have a drivers license? Yes No What type? Operator Commercial (CDL) Chauffeur Do you have reliable transportation? Yes No Have you had any accidents in the past three years? Yes No How many accidents? Have you had any Moving Violations in the past three years? Yes No How many Moving Violations?
