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2025-12-08T16:08:25+00:00
Job Application
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North Central West Virginia Community Action Association, Inc. is an equal opportunity employer. North Central West Virginia Community Action Association, Inc. does not discriminate on the basis of race, color, religion, creed, gender, national origin, age, disability, veteran status, or any other legally protected status.
Information
Email
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Position Applying For
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Date of Application
MM slash DD slash YYYY
County
(Required)
Barbour
Marion
Taylor
Randolph
Preston
Webster
Greenbrier
Pocahontas
Tucker
Do you have a valid driver’s license?
(Required)
Yes
No
Are you at least 18 yrs old?
(Required)
Yes
No
Age if Under 18?
How Did You Learn About Us?
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Advertisement
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Relative
Inquiry
Other
Contact Information
Name
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First
Middle
Last
Address
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Street Address
Address Line 2
City
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American Samoa
Arizona
Arkansas
California
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New York
North Carolina
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Northern Mariana Islands
Ohio
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Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Primary Phone
(Required)
Primary Phone Type
(Required)
Home
Cell
Secondary Phone
Secondary Phone Type
Home
Cell
Other
County
(Required)
Barbour
Marion
Taylor
Preston
Randolph
Pocahontas
Greenbrier
Tucker
Webster
Other Names That You Have Gone By
Previous addresses and dates for the past SEVEN years. When applicable, include addresses at which you resided while attending school.
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From
MM slash DD slash YYYY
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To
MM slash DD slash YYYY
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Address
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City
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State
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Zip
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From
MM slash DD slash YYYY
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To
MM slash DD slash YYYY
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Address
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City
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State
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Zip
Row End
Have you ever filed an application with us before?
(Required)
Yes
No
If Yes, give date
Have you ever been employed with us before?
(Required)
Yes
No
If Yes, give date
Does your spouse, any of your friends or relatives or a person living in your household work here?
(Required)
Yes
No
If Yes, state name, relationship, and location
Does a member of your family serve on the Board of Directors or Head Start Policy Council of North Central WV Community Action?
(Required)
Yes
No
If Yes, state name and relationship
Do you have a previous criminal conviction? (Conviction does not automatically disqualify an applicant from employment).
(Required)
Yes
No
If Yes, state date(s) and nature of conviction (s)
Are you currently employed?
(Required)
Yes
No
May we contact your present employer?
(Required)
Yes
No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status will be required upon employment)
(Required)
Yes
No
Education
Highest Level of Education Attained
(Required)
Less than High School/GED
High School/GED
Some College
Associates Degree
Bachelor's Degree
Graduate Degree
Doctorate
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High School Name and Address
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Course of Study/Major
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Diploma or Type of Degree
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Number of Years Completed
Column Break
Graduated
Yes
No
Row End
Row Start
Undergraduate College Name and Address of School
Column Break
Course of Study/Major
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Diploma or Type of Degree
Column Break
Number of Years Completed
Column Break
Graduated
Yes
No
Row End
Work Experience
Work Experience 1-3
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Employer
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Address
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Telephone Numbers
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Starting/Present Title
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Supervisor
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Reason for Leaving
Row End
Row Start
Employed From:
MM slash DD slash YYYY
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Employed To:
MM slash DD slash YYYY
Column Break
May We Contact?
Yes
No
Row End
Row Start
Job Duties
Row End
Work Experience 2-3
Row Start
Employer
Column Break
Address
Column Break
Telephone Numbers
Starting/Present Title
Column Break
Supervisor
Column Break
Reason for Leaving
Row End
Row Start
Employed From:
MM slash DD slash YYYY
Column Break
Employed To:
MM slash DD slash YYYY
Column Break
May We Contact?
Yes
No
Row End
Row Start
Job Duties
Row End
Work Experience 3-3
Row Start
Employer
Column Break
Address
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Telephone Numbers
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Starting/Present Title
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Supervisor
Column Break
Reason for Leaving
Row End
Row Start
Employed From:
MM slash DD slash YYYY
Column Break
Employed To:
MM slash DD slash YYYY
Column Break
May We Contact?
Yes
No
Row End
Row Start
Job Duties
Row End
List professional certifications and licenses
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Type of certificate/license
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Issuing Authority
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Issue Date
MM slash DD slash YYYY
Column Break
Expiration Date
MM slash DD slash YYYY
Row End
Row Start
Type of certificate/license
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Issuing Authority
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Issue Date
MM slash DD slash YYYY
Column Break
Expiration Date
MM slash DD slash YYYY
Row End
Row Start
Type of certificate/license
Column Break
Issuing Authority
Column Break
Issue Date
MM slash DD slash YYYY
Column Break
Expiration date
MM slash DD slash YYYY
Row End
Describe any specialized training or skills
List professional, business or civic activities
Please exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other legally protected status.
Additional Information: Other Qualifications/Relevant Volunteer Activities/Comments
Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE REVIEWED THE ESSENTIAL FUNCTIONS OF THE POSITION(S) FOR WHICH YOU ARE APPLYING.
Are you capable of performing with or without reasonable accommodation(s), the essential functions of the position(s) for which you are applying? A review of the activities involved in such a job or occupation has been given.
(Required)
Yes
No
Personal/Professional References Include a minimum of one professional reference. Do Not include family members or past or current supervisors.
Row Start
Personal/Professional
Column Break
Name
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Address
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Phone Number
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Best Time to Call
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Occupation
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Personal/Prefessional
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Name
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Address
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Phone Number
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Best Time to Call
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Occupation
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Personal/Professional
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Name
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Address
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Phone Number
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Best Time to Call
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Occupation
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