Employment ApplicationInside CordiaAbout CordiaMissionCore ValuesFounder’s MessageHistoryJoin Our TeamCordia CultureCurrent PositionsAppy NowCordia WeeklyHappeningsResourcesEmployment ApplicationApplication Date* MM slash DD slash YYYY Position applying for:*Department:Personal InformationName* First Middle Last Present Address* Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Region ZIP Code Home Phone*Mobile PhoneEmail* If hired, when can you begin employment with Cordia?* MM slash DD slash YYYY Are you at least 18 years old?* Yes NoHiddenBirth date MM slash DD slash YYYY HiddenCordia work historyHave you ever worked for Cordia previously? Yes NoHiddenPlease provide job title, department, and dates of employment:HiddenAre you legally authorized to work in the United States?* Yes NoAre you willing to work with individuals who may display challenging behaviors?* Yes NoAre you able to provide physical assistance to individuals as needed?* Yes NoAre you able to bend, kneel, lift (up to 25 pounds), stoop, stand and/or sit for long periods of time, work in a community environment, handle wheelchair requirements (if needed), with our without reasonable accommodation?* Yes NoEducational HistoryAre you a high school graduate?* Yes NoHigh school name & city, state location: Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Region School(s) beyond high school (please list names and locations of the schools):Graduated? Yes NoDegree(s)/Certificate(s) Earned:Record of Employment (last 10 years)Cordia will confirm dates of employment, positions held, reasons for leaving with prior employers. Explain ALL gaps in employment and other information relevant to eligibility, qualification, and suitability with prior employers in the “Additional Information” section.Name of present or last employer:*Employer address Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Region Full time or Part time?* Full time Part timeType of business*Name of supervisor*Phone*Start date* MM slash DD slash YYYY End date* MM slash DD slash YYYY Your job title*Starting pay*Ending pay*Reason for leaving*Description of work and responsibilities*Add 2nd employer? Yes NoHiddenPrevious EmployerName of employerEmployer address Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Region Full time or Part time? Full time Part timeType of businessName of supervisorPhoneStart date MM slash DD slash YYYY End date MM slash DD slash YYYY Your job titleStarting payEnding payReason for leavingDescription of work and responsibilitiesAdd 3rd employer? Yes NoHiddenPrevious EmployerName of employer:Employer address Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Region Full time or Part time? Full time Part timeType of businessName of supervisorPhoneStart date MM slash DD slash YYYY End date MM slash DD slash YYYY Your job titleStarting payEnding payReason for leavingDescription of work and responsibilitiesAdd 4th employer? Yes NoHiddenPrevious EmployerName of employer:Employer address Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Region Full time or Part time? Full time Part timeType of businessName of supervisorPhoneStart date MM slash DD slash YYYY End date MM slash DD slash YYYY Your job titleStarting payEnding payReason for leavingDescription of work and responsibilitiesAdd more employers? Yes NoHiddenMore EmployersAdd additional employers, dates worked and description of dutiesUpload ResumeAccepted file types: doc, pdf, Max. file size: 128 MB.I understand that, if accepted for employment, I shall be required to provide proof of identity and eligibility to work in the United States (in compliance with the Immigration Reform & Control Act of 1986), as a condition of employment. In connection with this application, I authorize all corporations, companies, credit agencies, education institutions, persons, law enforcement agencies, military services, and former employers to release information that they may have about me to Cordia or its agents and release them from any liability for doing so. Also, I understand that a medical exam, pre-employment drug testing and/or criminal/abuse/neglect checks may be performed and that any offer of employment and continued employment is contingent upon receipt of satisfactory clearance.I understand that this application does not, by itself, create a contract of employment. I also understand that an acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future. I further understand and agree that, if accepted for employment by Cordia or its subsidiaries, I will have no expectation of privacy in the property owned by the organization.I understand that if employed, I have been hired at the will of my employer and that my employment may be terminated at any time, with or without cause and with or without notice.Confirmation of Accuracy*I understand that any misleading or incorrect statements may render this application void. I agree the company is not liable in any response if my employment is terminated because of false statements, answers, or omissions by me in the application. I agree.NameThis field is for validation purposes and should be left unchanged.
