Charlotte White Center Employment Application
PLEASE NOTE:

The Charlotte White Center does background checks pertaining to child/Adult abuse or neglect, driving and criminal records. Therefore, please make sure to read the Criminal, Children's, and Motor Vehicle Explanation near the end of the application.

This form is not intended to be printed. If you would like a print version or an application mailed to you please send your name and address to hr@charlottewhite.org.

Thank you for your cooperation, and we look forward to receiving your application.

The Charlotte White Center is a non-profit corporation.

First Name *
Your answer
Middle Name
Your answer
Last Name *
Your answer
Please list any previous names known by (i.e.: maiden, ect.)
Your answer
Street Address *
Your answer
Mailing Address (If different)
Your answer
State *
Your answer
City *
Your answer
Zip Code *
Your answer
Home Phone Number *
Your answer
Business/Cell Number *
Your answer
Email Address *
Your answer
Position applying for *
Your answer
How were you referred to us? *
Have you ever worked for the Charlotte White Center before? *
If yes, when?
Your answer
Minimum salary requirement per hour *
Your answer
Date available for work *
Your answer
Work Availability? *
Required
Skills:
Have you ever been convicted of a criminal offense or misdemeanor? *
If yes, give details including dates
Your answer
Do you have a valid driver's license? *
License Number
Your answer
Do you have motor vehicle insurance? *
Have you ever been convicted of any motor vehicle violations including speeding tickets, accidents, suspensions, OUI, etc.? *
If yes, give details including dates:
Your answer
Have you ever been investigated or interviewed by DHHS, APS or any other stage agency for child abuse/neglect/exploitation or abuse/neglect/exploitation to individuals with disabilities? *
If yes, explain:
Your answer
Are you legally authorized to work in the United States? *
If you are under 18 years of age, can you provide required proof of your eligibility to work?
Please check if you are currently a guardian, family member, or correspondent of anyone receiving services by the Charlotte White Center. *
Required
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