AFRC Job ApplicationInterested in working with Advocates for Recovery Colorado? Please complete the application and we will reach out once it is reviewed. Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Are you authorized to work in the U.S? * Yes No Are you 18 years of age or older? * Yes No What languages do you read, speak or write fluently? If selected for employment, are you willing to submit to a background check? Yes No Have you ever worked or attended school under another name? If so, under what name? Position Desired: Start date available MM DD YYYY Wage rate desired Days of week you are available to work Check all that apply Monday Tuesday Wednesday Thursday Friday Saturday Sunday Are you able to work Check all that apply Weekends Nights Holidays Overtime Have you previously worked for Advocates for Recovery Colorado? Yes No Education - School 1 Please Include: School Name, Location, Years Attended, Degree Received, Major Education - School 2 Please Include: School Name, Location, Years Attended, Degree Received, Major Education - School 3 Please Include: School Name, Location, Years Attended, Degree Received, Major Other education, training, certifications, or special skills: Are you experienced in using personal computers? Yes No Are you able to use Microsoft Office? * Yes No Are you able to use Salesforce? Yes No What other programs are you capable of using? Work Experience Please list previous employment for the past five years, beginning with the most recent. Employer Phone Number Address: Dates of Employment: Position Held: Reason for Leaving: Supervisor's Name & Title: May we contact them? Yes No Phone Number Description of Duties: Starting Compensation - Final Compensation Employer 2 Employer Phone Number Address: Dates of Employment: Position Held: Reason for Leaving: Supervisor's Name & Title: May we contact them? Yes No Phone Number Description of Duties: Starting Compensation - Final Compensation Employer 3 Employer Phone Number Address: Dates of Employment: Position Held: Reason for Leaving: Supervisor's Name & Title: May we contact them? Yes No Phone Number Description of Duties: Starting Compensation - Final Compensation Employer 4 Employer Phone Number Address: Dates of Employment: Position Held: Reason for Leaving: Supervisor's Name & Title: May we contact them? Yes No Phone Number Description of Duties: Starting Compensation - Final Compensation Professional References Name First Name Last Name Phone (###) ### #### Email Position or Title Years Known Reference 2 Name First Name Last Name Phone (###) ### #### Email Position or Title Years Known Reference 3 (Or personal reference) Name First Name Last Name Phone (###) ### #### Email Position or Title Years Known Authorization and Acknowledgements I affirm that the information I have provided in this application is true to the best of my knowledge, information, and belief, and I have not knowingly withheld any information requested. I understand that withholding or misstating any information requested in this application is grounds for rejection of my application, and that providing false or misleading information in this application is grounds for discharge. I authorize the company to verify my references, record of employment, education record, and any other information I have provided. Unless otherwise noted, I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers and all other persons and entities, from all claims, demands or liabilities arising out of or in any way related to such inquiry or disclosure. Applicant's Digital Signature * Date * MM DD YYYY Thank you! We will review your application.
