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BCFS Job Application - Email To HR@ PDF

This document is an employment application for BCFS. It requests personal information such as name, address, phone number, email, availability, languages spoken, citizenship status, education history, references, previous employment details, military service record, and requires an electronic signature. The applicant is asked to disclose any felony convictions and authorize contacting previous supervisors for references. It notes the application will be considered without discrimination and a background check will be performed.

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Mes Ruben
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191 views

BCFS Job Application - Email To HR@ PDF

This document is an employment application for BCFS. It requests personal information such as name, address, phone number, email, availability, languages spoken, citizenship status, education history, references, previous employment details, military service record, and requires an electronic signature. The applicant is asked to disclose any felony convictions and authorize contacting previous supervisors for references. It notes the application will be considered without discrimination and a background check will be performed.

Uploaded by

Mes Ruben
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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BCFS Employment Application

Applicant Information
Full Name:

Date:
Last

First

M.I.

Address:
Street Address

Apartment/Unit #

City

State

Phone:
Date Available:

ZIP Code

Email
______________

Social Security #:

Desired Salary:

Position Applied for:


What Languages do you speak fluently? _____________________________________________________________________
Are you a citizen of the United States?
Have you ever worked for BCFS?
Have you ever been convicted of a felony?

YES

NO

YES

NO

YES

NO

If no, are you authorized to work in the U.S.?

YES

NO

If yes, when?

If yes, explain:

Education
High School:
From:

City/State:
To:

Did you graduate?

College:
From:

City/State:
To:

Did you graduate?

Other:
From:

City/State:
To:

Did you graduate?

YES

YES

NO

YES

NO

NO

Diploma:

Degree:

Degree:

References
Please list three professional references.
Name: ________________________________ Company: _______________________ Phone: ____________________
Name: ________________________________ Company: _______________________ Phone: ____________________
Name: ________________________________ Company: _______________________ Phone: ____________________

Military Service
Branch:

From:

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

To:

Previous Employment
Company:

Phone:

City/State:

Supervisor:
Starting Salary:$

Job Title:

Ending Salary:

Responsibilities:
From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

YES

NO

Company:

Phone:

City/State:

Supervisor:
Starting Salary:$

Job Title:

Ending Salary:$

Responsibilities:
From:

To:

Reason for Leaving:


YES

May we contact your previous supervisor for a reference?

NO

Company:

Phone:

City/State:

Supervisor:
Starting Salary:$

Job Title:

Ending Salary:$

Responsibilities:
From:

To:

Reason for Leaving:


YES

May we contact your previous supervisor for a reference?

NO

Disclaimer and Signature


Applicants are considered without regard to race, color, sex, national origin, age, or the presence of a disability that does not
impair the individual from performing the functions of the position with or without reasonable accommodations. The applicant
will be fairly considered; however, the completion of application does not imply that he applicant will be employed or accepted
as a volunteer. BCFS maintains a "Zero Tolerance" for abuse or harassment.
CERTIFICATION
I certify that the answers given by me to the foregoing questions are true and correct without any material or consequential
omissions. I understand that any misleading or incorrect statements may render this application void, and, if discovered
after approval for employment or as a volunteer, would be cause for my termination. I further agree that BCFS, or a controlled
entity of BCFS, shall not be liable in any respect if my position is terminated because of my having falsified or made
erroneous statements, answers, or omissions on this application. T also release the companies, schools, or persons from
any and all liability for any damage for issuing a reference or information about me, my job performance, or record to BCFS,
or a controlled entity of BCFS. I also understand that background checks will be made of my driving record, any criminal
record, and any abuse/neglect investigations.
Furthermore I understand and agree that if I am hired, my position with BCFS, or a controlled entity of BCFS, is for an
indefinite period of time and is at-will, so that either BCFS or I are free to choose to end our relationship at any time for any
reason, with or without notice.
Signature:

Date:

Email this completed application to HR@BCFS.net. Attach a resume to the email, if possible.

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