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email application to bladkids1@zoomtown.com
Due an over whelming response BLAD4KIDS can no longer accept faxes. you can return applications by mail to:
BLAD Talent Agency P.O. Box 12311, Cincinnati, Ohio 45212
BLAD TALENT AGENCY APPLICATION FOR EMPLOYMENT
Please print or type all information.
Non-Discrimination Policy: BLAD TALENT AGENCY is committed to the principle of equal opportunity in education and BLAD AGENCY employment. The Agency does not discriminate on the basis of sex, race, color, creed, national origin, age, religion, sexual orientation, gender identity, gender expression, veteran status, or disability in admission to, access to, treatment in, or employment in its programs and activities.
GENERAL INFORMATION
Date
Position(s) Applied For (1) (2)
Referral Source ? Newspaper ?Friend ? Relative ? BLAD Agency
? Internet Search ? Professional Journal ? Other__________
Name
Last First Middle
Address
Number Street City State Zip
Home Telephone ( )
Cell Phone ( )
E-mail address
If under 18, can you provide a work permit? ? Yes ? No
Have you ever filed an application here before? ? Yes ? No If yes, give date
Have you ever been employed here before? ? Yes ?No If yes, give date
Are you currently employed? ? Yes ? No
If yes, may we contact your employer? ? Yes ? No
Are you a United States citizen? ? Yes ? No If no, do you have a valid work permit to gain employment in the US? ? Yes ? No
(Proof of citizenship or immigration status may be required upon employment)
Employment desired: ? Full-Time ? Part-Time ? Shift Work ? Temporary ? Overtime
When are you available for work?
Are you on a lay-off and subject to recall? ? Yes ? No
Can you travel if a job requires it? ? Yes ? No
SEALED RECORD NOTICE:
All applicants must complete this application upon training with a City of Cincinnati, Ohio and or what City you reside in a Police Background check in order to be consider for employment and or any of the BLAD Talent Agency Professional Programs/Projects. It is our Corporations Rights to protect/Serve our youth and its clients. Please attach your juvenile/adult police background ( the original police check) to your application. No COPIES will be EXCEPTED!
Applicants having sealed conviction records on file with the Commission of Probation may answer “no” to the following:
Within the past five years, have you been convicted of a misdemeanor? ? No ? Yes
(Applicants may answer “no” with respect to a first conviction for drunkenness, simple assault, minor traffic violations, affray, or disturbance of the peace). If yes, please explain. You may attach info to this application if more room is needed
Have you ever been convicted of a felony? ? No ?Yes
If yes, please explain. You may attach info to this application if more room is needed
EDUCATION
TYPE OF SCHOOL
NAME OF SCHOOL LOCATION
(Complete mailing address) NUMBER OF YEARS COMPLETED MAJOR & DEGREE
High School
College
Graduate School
Bus. or Trade School
Professional School
Special Honors
COMPUTER SKILLS (Only for positions which require computer skills)
Check off those computer skills with which you are proficient (any version).
? PC User ? Macintosh User ? Windows ? Microsoft Word ? Microsoft Access
? Microsoft Excel ? Microsoft Publisher ? Web Page Design/ Maintenance ? E-mail ? Internet
? Other. Please list
DRIVER’S LICENSE (Only for positions which require driving)
Do you have a driver’s license? ? Yes ? No
Driver’s license
number State of issue ? Operator ? Commercial (CDL) ?Chauffeur
Expiration date
Have you had any accidents during the past three years? ? Yes ? No
How many?
Have you had any moving violations during the past three years ? Yes ? No
How many?
MILITARY
Are you a veteran of the United States military service? ? Yes ? No If yes, what branch?
If yes, Date Entered Date Discharged
If yes, please describe any special skills or training acquired while in the service:
OTHER SPECIAL SKILLS
Please list other special skills you may have, e.g., fluency in other languages, licenses, special training required for the position for which you are applying, etc.
WORK EXPERIENCE
Please list your work experience beginning with your most recent job. If you were self-employed, give firm name. Attach additional sheets if necessary. Exclude organization names which indicate race, color, creed, national origin, age, religion, sexual orientation, gender identity, gender expression, veteran status, or disability.
Most Recent Employer
Dates Employed
From: To:
Work Performed
Address
Supervisor
Job Title
Reason for Leaving
Employer
Dates Employed
From: To:
Work Performed
Address
Supervisor
Job Title
Reason for Leaving
Employer
Dates Employed
From: To:
Work Performed
Address
Supervisor
Job Title
Reason for Leaving
Non-Discrimination Policy: BLAD is committed to the principle of equal opportunity in education, philanthropy and employment. The Agency does not discriminate on the basis of sex, race, color, creed, national origin, age, religion, sexual orientation, gender identity, gender expression, veteran status, or disability in admission to, access to, treatment in, or employment in its programs and activities.
Solely to help us comply with government record keeping, reporting, and other legal requirements, please fill out the Application Data Record. We appreciate your cooperation.
This data is for periodic government reporting and will be kept in a Confidential File separate from the Application for Employment.
Positions(s) applied for:
Referral Source ? Newspaper ? Friend ? Relative ? BLAD Agency
? Internet Search ? Mayor Mallory’s 2010 Job Fair ? Other__________
Name
Last First Middle Maiden
Address
Number Street City State Zip
Telephone ( )
Affirmative Action Survey Check one Check one Check any that apply
Government agencies require periodic reports on the sex, ethnicity, disability, and veteran status of applicants. Submission of information about a disability is voluntary. This data is for analysis and affirmative action only.
APPLICANT DATA RECORD
? Male
? Female
? White
? Black
? Hispanic
? American Indian/ Alaskan Native
? Asian/Pacific Islander ? Disabled ? Vietnam Era Veteran
? Disabled Veteran
REFERENCES
Please list two references other than relatives or previous employers.
Name
Position
Company
Address
Telephone ( )
Name
Position
Company
Address
Telephone ( )
WAIVERS AND DISCLOSURES
Please read each section carefully and sign where indicated.
AT-WILL EMPLOYMENT
It is my understanding that this employment application, or the granting of an oral interview, does not represent a contract of employment or a promise of future benefits by this organization. I understand and agree that, if hired, my employment will be at-will in nature and may be terminated, with or without cause, at any time, by either myself or my employer.
I also understand that this written statement supersedes any and all oral representations made by agents or representatives of this organization.
CERTIFICATION OF TRUTH AND ACCURACY
I certify that the information in this application is true, complete and correct. I understand that false answers, statements, or significant omissions made by me on this form shall be sufficient cause for denial of employment or discharge.
NOTIFICATION AND AUTHORIZATION TO REQUIRE A MEDICAL EXAMINATION
I hereby certify that, if hired, I will disclose any limitations I have that may impact my ability to do the job. I understand that I may also be required to undergo a pre-employment or post-employment medical exam by the Agency’s designated health practitioner.
NOTIFICATION AND AUTHORIZATION TO CONDUCT BACKGROUND INVESTIGATION
I understand that I may be subject to a background check, and hereby authorize Just facts Credential Verification, Inc. as an Agent for BLAD AGENCY, to investigate my background to determine any and all information of concern as to my record, whether same is of record or not, and I release employers and persons named in my application from all liability for any damages on account of his/her furnishing said information. Additionally, you are hereby authorized to make any investigation of my personal history, educational background, military record, motor vehicle records, criminal records and Original Police Background documents through an investigative agency or bureau of BLAD Talent Agency’s choice. I authorize the release of this information by the appropriate agencies to the investigating service. This authorization, in original or copy form, shall be valid for this and for any future reports and updates that may be required. I understand that passing the background check is a condition of employment. A negative background check can be grounds for dismissal, even if an offer has been made to me and I have been hired.
PLEASE SIGN HERE: __________________________________________
Date _____________________________
Non-Discrimination Policy: BLAD TALENT AGENCY is committed to the principle of equal opportunity in education and employment. The Agency does not discriminate on the basis of sex, race, color, creed, national origin, age, religion, sexual orientation, gender identity, gender expression, veteran status, or disability in admission to, access to, treatment in, or employment in its programs and activities. The following person has been designated to handle inquiries regarding the Agency’s nondiscrimination policies: Executive Director of Human Resources & Career Center, Ohio BLAD Talent Agency, PO. Box 12311 Cincinnati, Ohio, 45212. Inquiries concerning the application of nondiscrimination policies may be also referred to: Office for Civil Rights, Cincinnati, Ohio, Office,
U.S. Department of Education, 33 Arch Street, Suite 900 Boston, MA 02110 (617) 289-0111 FAX# (617) 289-0150; TDD (617) 223-9695 or at www.ed.gov.
Thank you for applying to BLAD TALENT AGENCY.
APPLICANT DATA RECORD
Thank you for applying to BLAD TALENT AGENCY Nonprofit Organization.
POSITIONS AVAILABLE:
FOOD SERVICE VENDING
PACKAGING WAREHOUSE/STORAGE
PROMOTERS SOUND CREW PRODUCTION & STAGE
CLEANING CREW STAGE PERFORMANCE
HOURLY PAY $8.00 -$10.00
EMAIL US AT:bladkids1@zoomtown.com
ALL STAFF MUST PROVIDE AN ORIGINAL COPY OF OHIO POLICE CHECK, WORK PERMIT, IDENTIFICATION SS# CARD (PROOF TO WORK IN USA)
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