CADAS, INC. APPLICATION FOR EMPLOYMENT
AN EQUAL OPPORTUNITY EMPLOYER
AND
DRUG FREE WORKPLACE

We do not discriminate based on race, ethnicity, religion, color, sex, age, national origin, sexual orientation, or mental or physical disability or medical condition, claims experience or genetic information

It is our intention that all qualified applicants are given equal opportunity and that selection decisions be based on job-related factors.

INSTRUCTIONS

Each question should be fully and accurately answered. You must be sure you have complete addresses and phone numbers listed for each employer, personal references and education. No action can be taken on this application until all questions have been answered. Upload additional documents if you do not have enough room on this application. In reading and answering the questions, be aware that none of the questions are intended to imply illegal perferences or discrimination based upon non-job-related information. Failure to completely fill out application in detail will have a bearing on the selection process.

Personal Information

Are you 18 years or older?

Yes No

Desired Employment

Are you employed now?

Yes No

If so, may we inquire of your present employer?

Yes No

Ever applied to this company before?

Yes No

Ever worked for this company before?

Yes No

Who referred you to this company?

Employment Agency Newspaper Advertising Friend State Employment Office College Placement Service Walk In Other

Education

General

Employment History

List below the five year of employment, starting with the most recent.

Employer

If there are gaps in time, please explain why. Enter none if there aren't any gaps in employment history.

Attach resume or additional documents

References

Below, give the names of three persons you are not related to, whom you have known at least five years.

Service Record

Criminal Record

Have you been convicted of a felony within the last 5 years?

Yes No

Are you on Federal Supervision at this time? This includes Federal Pretrial, Federal Probation or Federal Parole

Yes No

Employment Questionnaire

Are you interested in:

Part-time Full-time PRN

What shift's are you available to work?

First Shift Second Shift Third Shift

AFFIRMATIVE ACTION - DATA COLLECTION FORM

As an Equal Opportunity/Affirmative Action Employer and in compliance with federal directives pursuant to Executive Order 11246 (as amended by EO 11357), Council for Alcohol and Drug Abuse Services is required to maintain records of sex, ethnic background, disability and veteran status of all applications for employment. The form below should be completed and submitted by all applicants. It will not be placed in your application file. We appreciate your cooperation.

Check all that apply

Female Male Vietnam Era Veteran

Ethnic Category

White, not of Hispanic Origin - origins in any of the original people in Europe, North Africa or the Middle East Black, not of Hispanic origin - Origins in any of the original peoples of Africa Hispanic - origins of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture, regardless of race Asian or Pacific Islander - origins in any of the original people of the Far East, SE Asia, the Indian Subcontinent or Pacific Islands American Indian or Alaskan Native - Origins in any of the original people of North America who maintain cultural identification through tribal affiliation or community recognition,.

Authorization

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information that they may have, personal or otherwise and release the company from all liability from any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

Council for Alcohol & Drug Abuse Services, Inc.
314 Spears Ave
Chattanooga, TN 37405
423-756-7644

HIPAA
Notice of Privacy Practices

CADAS, INC. APPLICATION FOR EMPLOYMENTAN EQUAL OPPORTUNITY EMPLOYERANDDRUG FREE WORKPLACE

INSTRUCTIONS

CADAS, INC. APPLICATION FOR EMPLOYMENT
AN EQUAL OPPORTUNITY EMPLOYER
AND
DRUG FREE WORKPLACE