Page 1

Successful Transitions Logo
EMPLOYMENT APPLICATION
Applicant Information














Education


















References
Please list three professional references.















Previous Employment 1











Previous Employment 2











Previous Employment 3











Military Service






Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.


RELEASE AUTHORIZATION
AUTHORIZATION FOR CRIMINAL/COURT RECORDS CHECK
  1. In connection with my application for placement, I understand that an investigative report will be requested that will include information as to my character, work habits, performance, and experience along with reason for disciplinary action or termination or past employment. I understand that as directed by policy and consistent with the position described, you may be requesting information from public and private sources about my criminal record, driving record, education and previous employment.
  2. The fact that applicants have a criminal record will not be an automatic bar to employment or work as a volunteer. Factors such as age at the time of the criminal offense, seriousness and nature of the violation, time elapsed and subsequent rehabilitation will be taken into account.
  3. I acknowledge that a telephonic facsimile (fax) or photographic copy shall be as valid as the original. This release is valid for most federal, state, and county agencies.
  4. I hereby authorize, without reservation, any law enforcement agency, court, institution, information service bureau, school, employer or other organization or person contacted by the employer or its agent to furnish the information described in the attached request.
Furthermore, I, the undersigned, do, for myself, my heirs, executors and administrators, hereby remise, release and forever discharge and agree to indemnify National Federation of the Blind of South Carolina, NFBSC dba Successful Transitions, their officers, directors, employees and agents harmless from and against any and all causes of actions, suits, liabilities, costs, debts, and sums of money, claims and demands whatsoever, and any and all related attorney's fees, court costs, and other expenses resulting from the investigation of my background in connection with my application to become an employee or volunteer.


The following information is required by law enforcement agencies and other entities for positive identification purposes when checking records. It is confidential and will not be used for any other purpose.










Summer Teen Applicant Essay Questions

The final portion of this application contains several short essay questions. Please provide answers for each question.