Outreach Worker at Tri-County Community Action Agency

First Name *

Last Name

Email *

Phone *

Resume *

Date Available *

Do you have a valid driver's license? *

Do you have reliable transportation? *

Have you previously been employed with Tri-County Community Action Agency? *

If yes, when and position:

Were you referred by an employee of the agency? *

High School diploma *

If yes, name and location of school

GED *

If neither, indicate highest grade completed *

College/University

Location

Course of Study

Dates of Attendance

Hours Completed

Degree Received? *

If yes, please identify *

Year received

Identify any specialized training or skills you have

Are you registered, licensed, or certified in any special training?

Computer Proficiency

What software have you used?

Company Name

Company Address

Telephone Number

Employment Dates

Last position held

Job Function(s)

Reason for Leaving

May we contact Employer?

If No, please explain

Application Form