Basic Information Part I
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Basic Information Part II
If you selected full time please provide the shifts you are available. (1st, 2nd, 3rd) If you selected part time please provide the times you are available. (Morning, Afternoon, Evening).
What language(s) are you fluent in?
Employment History
Employer (1/5)
Employer (2/5)
Employer (3/5)
Employer (4/5)
Employer (5/5)
COMMENTS: Include explanation of any gaps in employment (please do not include medical or personal information)
Education
Your Submission will not be accepted if you do not complete the following section.
College
Bus/Trade/Tech
High School
NOTE: Official/Sealed Transcripts/Diploma will be required at time of hire if you are selected for employment.
Specialized Skills, Other Training, Certifications or Licenses
Please provide us information regarding your specialized skills. (i.e. WI Registry level, Early Education Classes, Computer programs you are proficient with, Typing {WPM}, Equipment you have used, Other Languages, etc...) If you have a WI Department of Public Instruction license, please state your license number. If you are registered with The Registry, please state your Registry level and identification number.
Electronic Signature
BY TYPING YOUR NAME IN THIS BOX YOU AGREE TO THE FOLLOWING: I CERTIFY THAT ANSWERS GIVEN HEREIN ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I AUTHORIZE LA CAUSA, INC TO INVESTIGATE ALL STATEMENTS CONTAINED IN THIS APPLICATION FOR EMPLOYMENT AS MAY BE NECESSARY IN ARRIVING AT AN EMPLOYMENT DECISION. I HEREBY UNDERSTAND AND ACKNOWLEDGE THAT, UNLESS OTHERWISE DEFINED BY APPLICABLE LAW, ANY EMPLOYMENT RELATIONSHIP WITH THIS ORGANIZATION IS OF AN “AT WILL” NATURE, WHICH MEANS THAT THE EMPLOYEE MAY RESIGN AT ANY TIME AND THE EMPLOYER MAY DISCHARGE EMPLOYEE AT ANY TIME WITH OR WITHOUT CAUSE. IT IS NOT CHANGED BY ANY WRITTEN DOCUMENT OR BY CONDUCT UNLESS SUCH CHANGE IS SPECIFICALLY ACKNOWLEDGED IN WRITING BY AN AUTHORIZED EXECUTIVE OF THIS ORGANIZATION. I UNDERSTAND THAT EMPLOYMENT OR CONTINUED EMPLOYMENT IS DEPENDENT UPON RECEIPT OF SATISFACTORY EMPLOYMENT/CHARACTER REFERENCES, DRUG TEST, GANG ACTIVITY STATEMENT, DRIVER'S RECORD, RESULTS OF A CRIMINAL HISTORY BACKGROUND CHECK AND ANY OTHER REQUIRED DOCUMENTATION. IN THE EVENT OF EMPLOYMENT, I UNDERSTAND THAT FALSE OR MISLEADING INFORMATION GIVEN IN MY APPLICATION OR INTERVIEW(S) AND/OR BACKGROUND DISCLOSURES MAY RESULT IN DISCHARGE. I ALSO UNDERSTAND THAT I AM REQUIRED TO ABIDE BY ALL RULES AND REGULATIONS OF THE EMPLOYER.
EEOC/AA Section
THIS SECTION IS SOLELY USED FOR EQUAL EMPLOYMENT OPPORTUNITY AND AFFIRMATIVE ACTION (EEO/AA) CONTRACT COMPLIANCE INFORMATION PURPOSES. La Causa, Inc. is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, La Causa, Inc. invites applicants to voluntarily self-identify their race or ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual. *THIS INFORMATION IS NOT SEEN BY THE HIRING SUPERVISOR* ****CHECK ONLY ONE BOX PER SECTION****
Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races.
Race/ethnic designations as used by the EEOC do not denote scientific definitions of anthropological origins. For the purposes of this report, an individual may be included in the group to which he/she appears to belong, identifies with, or is regarded in the community as belonging. However, no person should be in more than one race/ethnic group. Definitions are as defined in U.S. Department of Commerce, Office of Federal Statistical Policy and Standards' Directive No. 15. The definitions also appear in the EEO-1 Instruction Booklet.
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