CENTRAL ARKANSAS DEVELOPMENT COUNCIL …

1 CENTRAL ARKANSAS DEVELOPMENT COUNCIL APPLICATION FOR EMPLOYMENTIn compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, disability or military Desired:Date:Position(s) applying for:Location of position:*If yes, when and where?Referred by:When would you be available to start work?Personal InformationLast Name:First Name:Middle Initial:Social Security Number (SSN)Address:City:Phone Number:*If yes, on what jobs?*If yes, describe in full:List relatives on the CADC Board of Directors or employed by case of emergency, notify:Last Name:First Name:Phone Number:Address:City:State:Zip:Page 1 of 4 EQUAL employment OPPORTUNITY EMPLOYERHave you been convicted of a crime in the past 10 years, excluding misdemeanors and summary offenses?

2 Yes*NoHave you been bonded?Yes*NoWere you previously employed by CADC?Yes*NoState:Zip:(Answer All Questions - Please Print)If you would like a fillable form to electronically submit your application, please go to 2 of 4 EducationHigh SchoolName of SchoolAddress:City:State:Years Completed:CollegeYears Completed:State:City:Address:Name of School*If yes, degree obtained?DegreeEmployment HistoryStarting with your current, or recent employer, provide a ten (10) year employment :To:Company Name:Address:City:State:Zip Code:Salary:Position:Reason for leaving:Reason for leaving:Position:Salary:Zip Code:State:City:Address:Company Name:Reason for leaving:Position:Salary:Zip Code:State:City:Address:Company Name:EQUAL employment OPPORTUNITY EMPLOYERP hone Number:Phone Number:Phone Number:Degree*If yes, degree obtained?

3 Years Completed:State:City:Address:Name of SchoolTrade, Business, or Technical SchoolTo:From:To:From:*Resume may be attached. However, employment history must be completed to be considered.*Did you graduate?YesNo**If no, did you get your GED?YesNoN/AYes*NoDid you graduate?Yes*NoDid you graduate?Reason for leaving:Position:Salary:Zip Code:State:City:Address:Phone Number:Company Name:To:From:Page 3 of 4 EQUAL employment OPPORTUNITY EMPLOYERR eason for leaving:Position:Salary:Zip Code:State:City:Address:Phone Number:Company Name: employment History, continuedReason for leaving:Position:Salary:Zip Code:State:City:Address:Phone Number:Company Name:Reason for leaving:Position:Salary:Zip Code:State:City:Address:Phone Number:Company Name:To:From:To:From:To:From:Reason for leaving:Position:Salary:Zip Code:State:City:Address:Phone Number:Company Name:To:From:Reason for leaving:Position:Salary:Zip Code:State:City:Address:Phone Number:Company Name:To:From:Reason for leaving:Position:Salary:Zip Code:State:City.

4 Address:Phone Number:Company Name:To:From:Page 4 of 4 EQUAL employment OPPORTUNITY EMPLOYERR eferences:NameAddress:Phone Number:Years Acquainted:Years Acquainted:Phone Number:Address:NameYears Acquainted:Phone Number:Address:NameApplication must be filled out completely to be considered. Resumes will not be considered as part of the official employment application. applications with statements such as "See Resume" will not be considered as complete. I certify that the information provided in this Application for employment is true, correct, and complete. If employed, any misstatement or omission of fact on this application may result in my dismissal. I understand that prospective employees, or employees transferred into certain CADC positions, may be subject to a criminal background check, driver's record check, and/or pre- employment , and on-going, drug/alcohol testing.

5 I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue my employment in the *May we contact the employers listed?*If no, indicate which one(s) you do not wish us to contact:Are there any other experiences, skills, or qualifications which you feel would benefit you in this position?If in the general area, please return application to: CADC Attn. Human Resources 321 Edison Avenue Benton, AR 72015 Once completed, please mail application to: CADC Attn. Human Resources Box 580 Benton, AR 72018