Employment Application

Contact Information

Fields marked with ' * ' are mandatory

Select Date* :- Select Month* :- Select Year* :-
Last Name* :- First Name* :- Middle Name :-
Street Address* :- State* :- City ST ZIP Code* :-
Telephone:- Cell Phone:-    
Your Email* :-        

Employment Desired

Position* :-        
Select Date* :- Select Month* :- Select Year* :-
Salary Requirement* :- Full Time  Yes No Part Time  Yes No
Specific Hours / Days Available to Work Have you ever been previously employed or volunteered with MAAP?  Yes No
If “Yes”, please include dates of any previous employment and/or volunteer work with MAAP: From
To
Location
Do you have any relatives who work for MAAP, Inc. or are on the Board of Directors? (Y/N):
 Yes No
If “Yes”, provide the name of person and their relationship to you:
Do you possess a valid California Driver’s License?
 Yes No
How did you first learn about this position?
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?
 Yes No
If no, describe the functions that cannot be performed: (Note: We comply with the ADA and California Fair Employment and Housing Act and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.)
Have you ever been convicted of a criminal offense (felony or serious misdemeanor)? (Y/N) (Convictions for marijuana-related offenses that are more than two years old need not be listed
 Yes No
If yes, state the nature of the charge, the court and county, the date of the conviction, and the disposition of the case
(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, date of the offense, the surrounding circumstances, and the relevance of the offense to the position (s) applied for may however, be considered.)
Primary Language Spoken/Written/Understood* :- Other Language Spoken/Written/Understood:
Computer Skills: Please put an “X” next to each skill you are proficient in:
Word Excel PowerPoint Outlook 
Please indicate other computer skills:
Can you, after offer of employment, submit verification of your legal right to work in the United States? (Y.N)* :-
Answer the following questions if you are applying for a position that requires licensure or certification:
Are you licensed/certified/trained/accredited for the job applied for? (Y/N):
 Yes No
Name of license/certification/training/accreditation:
Issuing state or entity: License/Certification Number:
Has your license/certification/accreditation ever been revoked or suspended? (Y/N):
 Yes No
If “Yes”, state the reason(s), date of revocation or suspension and if applicable, date of reinstatement:

Education

Indicate Highest Grade Completed Graduate (Y/N) Name of School & Location (City, State) Major/Minor Degree Earned
High School (9  10  11  12)  Yes No
College  or University (1  2  3  4)  Yes No
Graduate School  Yes No
Other Training  Yes No

Other Professional Licenses & Certifications

Type  of License License Number Issue Date Issuing State Renewal Number Renewal Date

Former Employment

Employer
Address :
Phone
Immediate Supervisor & Title
Phone
 
Your Job Title:
Dates Employed:
 
Responsibilities:  
Reason for Leaving: Salary
May we contact this company for references? (Y/N):  Yes No  


Employer
Address :
Phone
Immediate Supervisor & Title
Phone
 
Your Job Title:
Dates Employed:
 
Responsibilities:  
Reason for Leaving: Salary
May we contact this company for references? (Y/N):  Yes No  


Employer
Address :
Phone
Immediate Supervisor & Title
Phone
 
Your Job Title:
Dates Employed:
 
Responsibilities:  
Reason for Leaving: Salary
May we contact this company for references? (Y/N):  Yes No  


Employer
Address :
Phone
Immediate Supervisor & Title
Phone
 
Your Job Title:
Dates Employed:
 
Responsibilities:  
Reason for Leaving: Salary
May we contact this company for references? (Y/N):  Yes No  

Acknowledgements and Signature

I understand and agree that if MAAP employs me, I will abide by its rules and regulations, including those set forth in MAAP’s Employee Handbook as may be amended from time to time. * :-

I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and MAAP, Inc. In addition, I understand and agree that if I am employed, my employment is at-will and for no definite and determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or MAAP, Inc and that no promises or representations contrary to the foregoing are binding on MAAP, Inc unless made in writing and signed by me and the designated representative at MAAP, Inc.* :-

I agree that any and all claims arising out of or related to my application for employment and/or employment (if offered) shall be submitted to final and binding arbitration and not to any other forum unless a specific law requires otherwise. This arbitration agreement is a waiver of all rights to a civil jury trial for claims of harassment, discrimination, wrongful termination, and/or any other claim arising out of my application for employment and employment (if offered) and any claims MAAP, Inc. may have against me arising out of my employment. The current Rules for the Resolution of Employment Disputes of the American Arbitration Association and the provisions of California Code of Civil procedure section 1283.05 shall be applicable to such arbitration. Venue for any such proceeding shall be in the County of Sacramento, State of California. Pending arbitration, either party may seek temporary injunctive relief from the appropriate court in circumstances otherwise authorized under state or federal law. Judgment upon the award rendered by the arbitrator may be entered in any court of competent jurisdiction. MAAP, Inc. shall pay all fees and costs of arbitration subject to the reallocation through the award of the arbitrator. In the event that they arise each side shall bear its own attorneys fees. If any court of competent jurisdiction declares that any part of this arbitration agreement is illegal, invalid or unenforceable, such a declaration will not affect the legality, validity or enforceability of the remaining parts of the agreement and the illegal, invalid or unenforceable part will no longer be part of this agreement.* :-

I hereby certify that all information contained in the application, and the resume I have submitted to MAAP, Inc, if any, is true and correct, and I authorize MAAP to contact any of my schools, former employers or other references, unless otherwise stated. I understand that if I am employed, any omission or misrepresentation of the facts stated or implied in this application or my resume is grounds for immediate termination.* :-

 
It is MAAP’s policy to fill every position without regard to race, color, religion, creed, sex, marital status, age, national origin, ancestry, disability, medical condition, sexual orientation, or any other consideration made unlawful by applicable federal, state, or local laws. MAAP, Inc. is an equal opportunity employer and selects employees on the basis of qualifications and their fit with the stated expectations of the position.* :-

Release for Reference Information

THREE PROFESSIONAL REFERENCES MUST BE OBTAINED

Applicant Name 
Date
I hereby authorize the references listed below to provide MAAP, Inc. any and all information concerning my previous employment and any pertinent information they may have. Further, I release all parties and persons from any and all liability for any damages that may result from furnishing such information to MAAP as well as from the use or disclosure of such information by MAAP, Inc. or any of its agents, employees, or representatives.* :-

 

Name Date
References must be the names of individuals from previous employers that are directly familiar with your work. Ideally these individuals should be at a supervisory level or above.


Name of Reference Phone
Company Name and Address:  
Relationship:  


Name of Reference Phone
Company Name and Address:  
Relationship:  


Name of Reference Phone
Company Name and Address:  
Relationship:  


Name of Reference Phone
Company Name and Address:  
Relationship: