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Main location
914 Market Street, Suite 106Parkersburg, WV
Mon - Fri • 8-4
304-485-6748
Nutrition Site
510 Columbia AvenueWilliamstown, WV
Mon - Fri • 11-12 (For Lunch Only)
304-485-6748
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Parkersburg, WV
Williamstown, WV
Nutrition
Enjoy Lunch With Us
Menu
Home Delivered Meals
Why Eat With Us
Benefits of Good Nutrition
In-Home Services
Our Services
Individual Services
Lighthouse
F.A.I.R.
Respite
Transportation
About
About
Meet the Team
Our Board
Our Community Partners
Careers
Volunteer / Teach A Class
What It Means To Be 60 Plus
Contact Us
Menu
Home
Our Centers
Parkersburg, WV
Williamstown, WV
Nutrition
Enjoy Lunch With Us
Menu
Home Delivered Meals
Why Eat With Us
Benefits of Good Nutrition
In-Home Services
Our Services
Individual Services
Lighthouse
F.A.I.R.
Respite
Transportation
About
About
Meet the Team
Our Board
Our Community Partners
Careers
Volunteer / Teach A Class
What It Means To Be 60 Plus
Contact Us
Application For Employment
Position(s) Applied For
Date of Application
How did you learn about us?
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Employment Agency
Friend
Relative
Walk-In
Other
Name
First
Middle
Last
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Phone
Social Security #
If you are under 18 years of age can you provide required proof of your eligibility to work?
Yes
No
Have you ever been employed with us before?
Yes
No
If Yes, give date
Have you ever filed an application with us before?
Yes
No
If Yes, give date
Are you currently employed?
Yes
No
May we contact your present employer?
Yes
No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status
Yes
No
Proof of citizenship or immigration status will be required upon employment
On what date would you be available for work?
Are you available to work:
Full Time
Part Time
Shift Work
Temporary
Are you currently on “lay-off” status and subject to recall?
Yes
No
Do you have a valid driver’s license?
Yes
No
Can you travel if a job requires it?
Yes
No
Have you been convicted of a felony?
Yes
No
The position you are applying for may require lifting as part of the job-related tasks. Is there any reason you would not be able to perform these duties?
Yes
No
Education
Elementary School
School Name & Location
Years Completed
4
5
6
7
8
Diploma/Degree
High School
School Name & Location
Years Completed
9
10
11
12
Diploma/Degree
Describe Course of Study
Describe any specialized
Describe any honors you have received
State any additional information you feel may be helpful to us in considering your application
College/University
School Name & Location
Years Completed
1
2
3
4
Diploma/Degree
Describe Course of Study
Describe any specialized
Describe any honors you have received
State any additional information you feel may be helpful to us in considering your application
Graduate/Professional
School Name & Location
Years Completed
1
2
3
4
Diploma/Degree
Describe Course of Study
Describe any specialized
Describe any honors you have received
State any additional information you feel may be helpful to us in considering your application
Indicate any foreign languages you can speak, read and / or write.
Language
Speak
Fluent
Good
Fair
Read
Fluent
Good
Fair
Write
Fluent
Good
Fair
Language
Speak
Fluent
Good
Fair
Read
Fluent
Good
Fair
Write
Fluent
Good
Fair
Language
Speak
Fluent
Good
Fair
Read
Fluent
Good
Fair
Write
Fluent
Good
Fair
List professional, trade, business or civic activities and offices held.
You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, or handicap or other protected status.
References
Give name, address and telephone number of three references who are not related to you and are not previous employers.
Reference 1
Reference 2
Reference 3
Have you ever had any job-related training in the United States military?
Yes
No
If Yes, please describe:
Employment Experience
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, handicap or other protected status.
Employer
Phone
Address
Street Address
City
State / Province / Region
Job Title
Supervisor
Work Performed
Dates Employed
From
To
Hourly Rate/Salary
Starting
Final
Reason for Leaving
Employer
Phone
Address
Street Address
City
State / Province / Region
Job Title
Supervisor
Work Performed
Dates Employed
From
To
Hourly Rate/Salary
Starting
Final
Reason for Leaving
Employer
Phone
Address
Street Address
City
State / Province / Region
Job Title
Supervisor
Work Performed
Dates Employed
From
To
Hourly Rate/Salary
Starting
Final
Reason for Leaving
Special Skills and Qualifications
Summarize special job-related skills and qualifications acquired through other experience.
We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran’s status, the presence of a non-job-related medical condition or handicap, or any other legally protected status.
Applicant’s Statement
I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an ”at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. I understand that employment at WCSCA is at will and that either WCSCA or I can terminate the employment relationship at any time, for any reason, with or without notice. I further understand that neither this application nor any other WCSCA communication I may receive constitutes an employment contract. If provided, I authorize the WCSCA to contact any or all of my references and former employers listed herein and to inquire about my employment there. I release WCSCA and any employer or reference which is contacted from any liability arising out of such inquiry or the response to such inquiry. I certify that the statements contained herein are true to the best of my knowledge and belief. I understand that any false or misleading statement, receipt of unsatisfactory references, an unsatisfactory result of drug screening test, an unsatisfactory result of a criminal background check or an unsatisfactory result of any physical examination which reveals that I cannot perform the essential functions of my job with or without accommodation may result in ineligibility for hire and/or discharge.
Signature of Applicant
Date
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