C.A.C.H.E. INC.
63-65 SOUTH MAIN STREET
LIBERTY, N.Y. 12754
TELE: (845) 292-5821
FAX: (845) 292-0724
 
APPLICATION FOR EMPLOYMENT

TODAY'S DATE:
POSITION APPLIED FOR:
NAME:
SS#:
ADDRESS:
CITY:
STATE: ZIP:
TELEPHONE #:
DATE AVAILABLE TO WORK:
ARE YOU EMPLOYED?:
YES: NO:
IF SO, MAY WE CONTACT YOUR EMPLOYER?:
YES: NO:

ARE YOU BETWEEN 18 AND 65 YEARS OF AGE?: YES: NO:

DO YOU HAVE A VALID DRIVER'S LICENSE?: YES: NO:

ARE YOU LEGALLY ELIGIBLE FOR EMPLOYMENT IN THIS COUNTRY?: YES: NO:
(PROOF OF U.S. CITIZENSHIP OR IMMIGRATION STATUS WILL BE REQUIRED UPON EMPLOYMENT)
HAVE YOU EVER BEEN CONVICTED OF A CRIME?: YES: NO:
IF YES, PLEASE GIVE A BRIEF EXPLANATION OF WHEN, WHERE, AND HOW DISPOSED:
ARE YOU RELATED TO ANYONE CURRENTLY HOLDING A SEAT ON THE C.A.C.H.E. BOARD OF DIRECTORS, OR ANYONE EMPLOYED BY THE C.A.C.H.E., AGENCY?: YES: NO:
NAME:
POSITION:

EDUCATION:
DO YOU HAVE A HIGH SCHOOL DIPLOMA?:YES: NO:
IF NO, HAVE YOU OBTAINED YOUR G.E.D?: YES: NO:
 
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