Communities In Schools of the Heart of Texas
Application
1001 Washington Avenue
Waco, TX 76701
In compliance with applicable laws, CIS - HOT does not discriminate on the basis of age, race, religion, color, national origin, gender, handicap, or
sexual orientation. Auxiliary aids and services will be made available upon request to persons with disabilities, as required by law.
Personal Information
Date: ___________
Daytime Phone #: __________________
Cell #: ______________________
Full Name: ______________________________________________________________________________________________________
Mailing Address: __________________________________________________________________________________________________
Permanent Address: _______________________________________________________________________________________________
Email Address:
Position Desired
Are you at least 17 years of age? Yes / No
Check all that apply
Part Time Positions
____ Volunteer: Type of volunteer interests: _______________________________________________________________________________
____ Workstudy: Must have a Certified Referral Form from your financial aid office
____ Data Entry Specialist
____ Afterschool Manager: Monday-Friday Afternoon schedule
____ Afterschool Staff: Monday-Friday Afternoon schedule
Full Time Postions
____ Case Manager / Outreach Worker - Located on a School Campus or an Alternative Work Site
____ Program Manager - Located on a School Campus or an Alternative Work Site
____ Program Coordinator - Located at CIS-HOT Central Office
____ Other: ________________________________________________________________________________________________________
Are you employed now? Yes / No
If so, may we contact your employer? Yes / No
Are you willing to work hours other than 8-5? Yes / No
Date available for work _______________
Are you willing to occasionally travel? Yes / No
Do you smoke, including e-cigarettes? Yes / No
Do you have any relatives working for, or on the Board of Directors of, CIS - HOT or the HOT Workforce System or in School Districts in the
following counties: McLennan, Freestone, Limestone, Hill, Bosque or Falls? Yes / No
If so, please list their names and relationship to you: _____________________________________________________________________________
How did you hear about CIS-HOT? ________________________________________________________________________________________
Education
Name & Location
Graduate?
High School
Yes / No
Undergraduate College
or University
Yes / No
Graduate School
Yes / No
Technical or
Vocational School
Yes / No
Dates Attended
Subjects Studied & Degree(s) Received
Experience
List employers for the last 10 years, starting with your current job. You may substitute
a resume only if it contains all of the requested information. However, feel free to include a resume if it contains additional relevant
information. This section is optional for volunteers.
Month
Ending
Immediate Supervisor
& Year
Salary
Job Title
Name & Address of Employer
& Phone Number
Reason(s) for Leaving
from
to
from
to
from
to
from
to
from
to
from
to
from
to
from
to
List relevant Volunteer involvement:
Month
& Year
Name & Address of Agency or Organization
Volunteer Role & Responsibilities
Immediate Supervisor
& Phone Number
from
to
from
to
from
to
from
to
Skills
Relevant License or Certification
(LSW, ACP, First Aid, Child Care, etc.)
Complete all that apply
Date Issued
Name of Issuing Authority
License Number
Special skills or areas of expertise that could enhance your job performance:
Areas of interest or hobbies that could enhance your job performance:
Involvement with clubs or organizations that could enhance your job performance:
Languages other than English:
Speak _______
Write _______
How Fluent? Fair _____ Good _____
Both _______
Excellent _____
References
Identify at least 3 people unrelated to you, whom you have known for at least 1 year.
Work-Study applicants must have 3 reference letters submitted on their behalf directly to CIS - HOT attached to this application.
Name
Address & Phone Number
Volunteer Applicants
Business
Years Acquainted
Complete only if you are applying to serve as a Volunteer, as opposed to a paid position
When are you available? Time(s) ____________________________ Day(s) of the Week ____________________________
Are you a part of a group volunteer project? Yes / No
If Yes, please identify the group: __________________________
If you have a special interest in one of our service sites, please indicate so below. Otherwise, you will be placed where the need is
currently greatest:
Work-Study Applicants
Complete only if you are applying for a Work-Study position
Classification: __________________________
Position applying for:
___ Site Supervisor
Major: __________________________
___ Program Assistant
___ Tutor/Mentor ( ___ Elementary ___ Secondary)
If you have previously worked or volunteered on a school campus, please note this in the "Experience" section above.
Please note any previous Work-Study experience above as well.
Applications must have a Certified Referral Form from the financial aid office and 3 reference letters.
Applicant Signature
Please read the following and indicate your understanding and acceptance by signing.
*I certify that all the information provided by me in connection with my application, whether on this document or not, is true and
complete, and I understand that any misstatement, falsification, or omission of information may be grounds for refusal to hire, or if
hired, termination, and possibly for a referral to law enforcement authorities.
*I understand that as a condition for employment, I will be required to provide legal proof of authorization to work in the U.S.
*I understand that CIS - HOT may check a variety of sources for any criminal history, in accordance with applicable law.
*I authorize any of the persons or organizations referenced in this application to provide CIS - HOT all information concerning my
previous employment, education, suitability for working with young persons, and any other information they may have related to me.
I waive any claim against and release from liability all such parties, CIS - HOT, and all those affiliated with any of them, for matters
in any way arising out of obtaining, releasing, or relying on any such information or opinion about me.
*ARBITRATION--In exchange for the opportunity to be considered for employment or retention as a volunteer by CIS - HOT, I agree
that any dispute arising out of this application or subsequent services for or employment by CIS - HOT, or any other claim made by
me against CIS - HOT--to the extent it otherwise would be resolved by a jury trial at court--instead will be resolved with third-party
neutral, binding arbitration in McLennan County, under the Federal Arbitration Act. If that Act nonetheless does not apply, then
under Texas law. This agreement is entered into and to be considered performed in McLennan County.
Signature: __________________________________________________________________________ Date:_________________
To complete your application, attach a letter outlining your interest and qualifications for the position.
To learn more about employment with CIS - HOT, please visit our website at www.cis-hot.org