Application for Employment

To avoid delays in the review of your application, please complete the application in its entirety; sending a resume is not an acceptable response. Please do not complete more than one application.

First Name *

Middle Name

Last Name *

Have you ever used a different name? *

Yes
No

If yes, please list names

Present Street Address

Address *

City *

State *

Zip Code *

Permanent Address (if different)

Address

City

State

Zip Code

Daytime Phone *

Evening Phone *

Cell Phone

Email *

Resume Upload

Have you ever been an employee or volunteer at any diocesan location, including the Diocese of Syracuse, Toomey Residential, or Christopher Community? *

Yes
No

If yes, give details

If you are under the age of 18 can you furnish a work permit? *

Yes
No
Not Applicable

The Position that I am applying for *

I am interested in employment opportunities *

Full-Time
Part-Time

Availability *

I am a U.S. Citizen or have the legal right to accept employment in the U.S. (proof of employment eligibility will be required at the time of hire) *

Yes
No

Have you ever received Child and Youth Protection Training? *

Yes
No

If yes, where/when/by whom?

If yes, give the date and provider of your last Criminal Background Check

Education & Training

Name and location of High School *

Degree Received/Area of Study *

Diploma? *

Yes
No

Name and location of College

Degree Received/Area of Study

Diploma?

Yes
No

Name and location of Postgraduate School

Degree Received/Area of Study

Diploma?

Yes
No

Name and location of other training

Degree Received/Area of Study

Additional education & training comments:

Employment & Volunteer Activities

List all present and former employment and volunteer activities beginning with your present or most recent position.

Company/Organization *

Phone *

Address *

When to When? (Month & Year) *

Title *

Supervisor *

Reason for Leaving *

Hourly Wage *

Duties *

No further work history to report

Done

Company/Organization

Phone

Address

When to When? (Month & Year)

Title

Supervisor

Reason for Leaving

Hourly Wage

Duties

No further work history to report

Done

Company/Organization

Phone

Address

When to When? (Month & Year)

Title

Supervisor

Reason for Leaving

Hourly Wage

Duties

No further work history to report

Done

Company/Organization

Phone

Address

When to When? (Month & Year)

Title

Supervisor

Reason for Leaving

Hourly Wage

Duties

Have you served in the Armed Forces of the United States? *

Yes
No

Branch

Period of Active Duty

References

3 references required; include two (2) professional references including your most recent supervisor. If you have resided in this area for less than 2 years, please provide at least one reference from your previous area of residence.

Name *

Phone *

Email

Title *

Address *

City *

State *

Zip *

May we contact this reference? *

Yes
No
Upon Offer

Name *

Email

Phone *

Title *

Address *

City *

State *

Zip *

May we contact this reference? *

Yes
No
Upon Offer

Name *

Email

Phone *

Title *

Address *

City *

State *

Zip *

May we contact this reference? *

Yes
No
Upon Offer

If you have other skills that will aid you in this role please note and describe them. (i.e.: computer skiils, languages, medical, etc.)

Criminal History

All applicants must complete question 4. Complete questions 1, 2, & 3 if the position(s) you are applying for involves contact with children or other vulnerable individuals, i.e. elderly, developmentally disabled, etc.

1. Has a civil complaint ever been filed against you that alleged sexual misconduct or child abuse by you or your participation in or facilitation of such activities (including internal complaints given to management or supervisors at places of employment

Yes
No

If yes, explain. Please provide the date, nature, and place of the incident leading to the complaint; where the complaint was filed; disposition of the complaint; and identify by name and title the person(s) who investigated the complaint.

2. Section 424-a of the New York Social Services Law generally requires that persons applying for employment with agencies which provide services to children, applicants to adopt a child or applicants to be foster care parents be cleared with the State Central Registry to determine if they are the subject of an indicated child abuse or maltreatment report. Has the Department of Social Services (local or state) informed you that it has found you to have abused, neglected or maltreated a child?

Yes
No

If yes, please explain

3. Do you presently serve, or have you ever served, as a volunteer for any organization, entity or group in which you had contact with children or other vulnerable populations (e.g., elderly, developmentally disabled, etc.)?

Yes
No

If yes, please provide the name, address, and phone number of the organization, period of volunteer service, supervisor's name; and briefly describe your activities and/or duties.

4. Have you ever chosen not to renew or continue any employment or volunteer service, had your employment or volunteer service terminated, or been subject to any disciplinary action, for reasons relating to allegations of sexual misconduct or child abuse by you? *

Yes
No

If yes, please explain. Please include in your explanation the date, nature, and place of the occurrence(s) or allegations(s) and the disposition of the matter(s). Also, identify your employer and supervisor at the time by name, address and telephone number.

Have you ever been convicted of, or pled guilty to a crime (felony or misdemeanor)? *

Yes
No

If yes, please explain. Please include in your explanation the date and place of any conviction, and the crime for which you were convicted.

Important: Applicant's Certification

I certify that all information in this application and all other information which I have provided in order to apply for and to secure work with Catholic Charities is true, complete and correct.

I expressly authorize, without reservation, the agency, its representatives, employees and agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the agency, its agents, employees or representatives, for seeking, gathering and using truthful and non defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that this agency does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. I understand that this application remains current for only 60 days. At the conclusion of that time, if I have not heard from the agency and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the agency reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the agency is authorized to make any assurance to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the agency's director.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an 1-9 Form in this regard.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the agency's service, whenever it is discovered.

I promise to abide by the "Child and Youth Protection Policy" and other policies and procedures of Catholic Charities.

I acknowledge that I will be required to undergo a criminal background check and "Child and Youth Protection" training. I also acknowledge that I will be required to furnish proof of identity in association with the criminal background check and employment eligibility.

If applicable, per New York State Office of Mental Health and New York State Office of Mental Retardation and Development Disabilities, I understand that I will be required to submit to a Criminal History Records Check (fingerprint process) performed by the FBI as well as New York State Division of Criminal Justice Services; this check will be used to determine my eligibility for employment upon an ongoing review of my criminal history.

BY CHECKING THIS BOX, I AGREE I HAVE READ THROUGH APPLICANT'S CERTIFICATION. *

Yes

Contact Us About Application for Employment

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Present Street Address

Permanent Address (if different)

Education & Training

Employment & Volunteer Activities

References

Criminal History

Important: Applicant's Certification