Registration: World Connection

If you have not yet registered for access to our online scheduling system, please complete the following form.

* required field

* How did you hear about us?
If Other, where?
If you were referred by someone, who?
* Date Available
* Social Security Number
* Are you a citizen of the United States?
 Yes  No
* Have you previously ever worked for this company?
 Yes  No
If so, when?
* Have you ever been convicted of a felony?
 Yes  No
If yes, please explain.
Schedule Availability

* High School Name
* High School Address
* From
* To
* Did you graduate?
 Yes  No
 Yes  No

First Reference
* First Reference Name
* First Reference Occupation
* First Reference: How long have you known this person?
* First Reference Address
* First Reference Phone Number
Second Reference
* Second Reference Name
* Second Reference Occupation
* Second Reference: How long have you known this person?
* Second Reference Address
* Second Reference Phone Number

Third Reference
Third Reference Name
Third Reference Occupation
Third Reference: How long have you known this person
Third Reference Address
Third Reference Phone Number

Emergency Contacts
* 1. Emergency Contact Name
* 1. Emergency Contact Relationship
* 1. Emergency Contact Address
* 1. Emergency Contact Phone
* 2. Emergency Contact Name
* 2. Emergency Contact Relationship
* 2. Emergency Phone Number
2. Emergency Contact Address

Referrals - Do you know anyone who wants to work with us?
1. Name and Phone Number
2. Name and Phone Number
* Please type your name to show your understanding.

Employment History
List most recent employment first. Include summer or temporary jobs. Be sure all your experience or employers related to this job are listed here. No more than 10 years history recommended.
* Employer (1)
* Employer Address (1)
* Pay Rate (1)
* Position title/duties, skills (1)
Supervisor (1)
Telephone (1)
Start Date (1)
End Date (1)
Reason for Leaving (1)
* Employer (2)
* Employer Address (2)
* Pay Rate (2)
* Supervisor (2)
* Position title/duties, skills (2)
* Telephone (2)
* Start Date (2)
* End Date (2)
* Reason for leaving (2)

Other qualifications such as special skills, abilities or honors that should be considered:
Professional licenses, certifications or registrations:
Types of computers, software, and other equipment you are qualified to operate or repair:
Additional skills, including supervision skills, other languages or information regarding the career/occupation you wish to bring to World Connection's attention:

Have You Served In The Military
 Yes  No
start date
End Date

Disclaimer and Signature
* By checking this box, I am stating that I have read and agree to all policies in the employee handbook.
Refer to: Employee Handbook
* I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in termination. By clicking yes, I am indicating my agreement.

We store cookies and other data on your device to help us deliver our services. By using Shiftboard, you agree to our use of cookies and confirm that you have read and accept our privacy policy.  

Thank you for your interest!

Getting help...