APPLICATION FOR EMPLOYMENT

ALL PORTIONS OF THIS APPLICATION MUST BE COMPLETED

Equal access to programs, services, and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.
We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability,
marital or veteran status, or any legally protected class.
Name (Last) (First) (Middle) Date
Current Address: Telephone #
  Alternate #
City    State    Zip   
Are you legally entitled to work in the United States? Yes       No  
Have you ever applied for a job with J.C Christensen &
Associates(JCC), CareCall, Inc., or Prosource before?		 Yes       No  
If yes, where and when?    
Referred By:    
Have you ever worked for JCC, CareCall, Inc., or
Prosource before?		 Yes       No  
If yes, where and when?    
The position you are applying for?     Desired pay range:     Per  
Type of employment: Full-Time     Part-Time     Temporary     On-Call  
Will you accept part time employment? Yes       No  
If yes, specify the days and hours you are available.
If your application is considered acceptable, what date can you start?
Is your current age 16 years or older?     Yes       No 18 years or older?     Yes       No  
List any special skills or qualifications related to the job applied for?  
 
EDUCATION
School Name and Address of School Course of Study Years Completed Diploma / Degree
High School
Undergraduate College
Graduate/Professional
Other (specify)
WORK EXPERIENCE
Employer Date Employed
From     /     To		 Work Performed
Address
Phone
Job Title HourlyRate/Salary
Starting     Final
Supervisor
Reason for leaving May we contact?     Yes       No  
 
Employer Date Employed
From     /     To		 Work Performed
Address
Phone
Job Title HourlyRate/Salary
Starting     Final
Supervisor
Reason for leaving May we contact?     Yes       No  
 
Employer Date Employed
From     /     To		 Work Performed
Address
Phone
Job Title HourlyRate/Salary
Starting     Final
Supervisor
Reason for leaving May we contact?     Yes       No  
PERSONAL REFERENCES (NOT FORMER EMPLOYERS OR RELATIVES LIST 3
NAME AND OCCUPATION ADDRESS TELEPHONE NUMBER
MILITARY INFORMATION
Have you served in the armed forces? Yes   No   Branch Of Service
Total Months of Active Duty? Rank at Induction Highest Rank Obtained
Specialized Military Experience
SECURITY INFORMATION
Is there any reason you cannot be licensed or bonded by the state of Minnesota? Yes       No  
Have you ever been charged with, or convicted of, or been indicted for, or entered a plea to, any criminal offense? (Felony, Gross Misdemeanor or Misdemeanor), other than traffic violations, in any state or federal court? Yes       No  
If yes, list date, city, charge and disposition
Attach Resume or Cover Letter
Click Browse if you wish to attach a file to this application.