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Home Based Supports
Case Management
Supported Employment
Self Directed Services
CCP Career Opportunities
ILS Services
Helpful Resources
Employees
Senior Management
The possibilities are wide open!
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Position Application
Applicant Name
Title
First
Middle
Last
Suffix
Address
Street Address
Address Line 2
City
State / Province
Postal / Zip Code
Canada
United Kingdom
United States
Country
Primary Phone
###
-
###
-
####
Alternate Phone
###
-
###
-
####
Email Address
Are you legally eligible for employment in the US?
*
Yes
No
Are you 18 years or older?
*
Yes
No
Have you ever been employed by CCP or any of its affiliates? Check all that apply:
Beacon Community Services
CCP Community Services
CCP Family Services
CCP Consumer Self Directed Services
Community Connections Partnership
Meriwether Ventures
Star Services
CCP or any of its affiliates
If you have previously been employed by CCP or one of its affiliates, why did you leave?
Availability
What Position are you applying for?
*
Job Type
Part Time
Full Time
Temporary
Name of Referral Source: (Newspaper Ad, Job Fair, Friend/Family Member [Please enter name if friend or family member is a current employee of CCP], Other)
What Date are you available to start working?
MM
/
DD
/
YYYY
Availablity (check all that apply)
Mornings
Weekdays
Evenings
Weekends
Overnight Awake
Overnight Asleep
How many hours per week are you available/wish to work
35-40
25-34
20-24
10-20
<10
Other Available Hours
Do you have a valid Drivers License?
*
Yes
No
Do you have use of a automobile?
*
Yes
No
Education
High School
School Name / Address - High School
Years Completed - High School
1
2
3
4
Did You Graduate High School?
Yes
No
Course of Study - High School
College
Name of School / Address - College
Years Completed - College
1
2
3
4
Did You Graduate College?
Yes
No
Course of Study - College
Other Schooling
School Name / Address - Other
Years Completed - Other
1
2
3
4
Did You Graduate - Other?
Yes
No
Course of Study - Other
Do you have any other relevant experience, skills or qualifications?
Employment Record
Begin with present or most recent employer
Name - Employer 1
*
Position Title - Employer 1
Address - Employer 1
Street Address
Address Line 2
City
State / Province
Postal / Zip Code
Canada
United Kingdom
United States
Country
Phone - Employer 1
###
-
###
-
####
Employment Dates - Employer 1
Supervisor Name and Title - Employer 1
Duties Performed - Employer 1
Ending Wage - Employer 1
Reason for Leaving - Employer 1
Name - Employer 2
Position Title - Employer 2
Address - Employer 2
Street Address
Address Line 2
City
State / Province
Postal / Zip Code
Canada
United Kingdom
United States
Country
Phone - Employer 2
###
-
###
-
####
Employment Dates - Employer 2
Supervisor Name and Title - Employer 2
Duties - Employer 2
Ending Wage - Employer 2
Reason for Leaving - Employer 2
Name - Employer 3
Position Title - Employer 3
Address - Employer 3
Street Address
Address Line 2
City
State / Province
Postal / Zip Code
Canada
United Kingdom
United States
Country
Phone - Employer 3
###
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###
-
####
Employment Dates - Employer 3
Supervisor Name and Title - Employer 3
Duties - Employer 3
Ending Wage - Employer 3
Reason for Leaving - Employer 3
Professional References
Minimum of 2 References
Name/Title - Reference 1
*
Address - Reference 1
Street Address
Address Line 2
City
State / Province
Postal / Zip Code
Canada
United Kingdom
United States
Country
Phone - Reference 1
###
-
###
-
####
Name/Title - Reference 21
*
Address - Reference 2
Street Address
Address Line 2
City
State / Province
Postal / Zip Code
Canada
United Kingdom
United States
Country
Phone - Reference 2
###
-
###
-
####
Name/Title - Reference 3
Address - Reference 3
Street Address
Address Line 2
City
State / Province
Postal / Zip Code
Canada
United Kingdom
United States
Country
Phone - Reference 3
###
-
###
-
####
An Equal Opportunity Employer
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