Application for Employment
Complete by typing in the fields or by printing neatly. DO NOT LEAVE ANY BLANKS.

Applicant Information
Full Name: Date:

Last
Address:

First

Middle name Apartment/Unit # State Zip Code

Street Address City
Home Phone: Email Address: Do you have a valid Driver’s License Have you ever been employed by Marrakech? Have you ever completed an application with Marrakech before? Are you 18 and over? Did you attend Marrakech’s Academy for Human Service Training? I am looking for What is your availability?
YES YES YES YES YES NO NO NO NO NO

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Cell Phone:

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YES NO

Can we email you about your application status?

If yes, why did your employment end? If yes, month & year: If no, a work permit will be required. If yes, month & year: where?

Full-time Employment Part-time Employment Per Diem/Substitute Employment Sunday Monday Tuesday Wednesday Thursday 1st Shift 1st Shift 1st Shift 1st Shift 1st Shift nd nd nd nd 2 Shift 2 Shift 2 Shift 2 Shift 2nd Shift rd rd rd rd 3 Shift 3 Shift 3 Shift 3 Shift 3rd Shift rd Awake and/or Asleep If 3 shift, please indicate: Hartford New Britain Meriden Waterbury Prospect Wolcott

Friday 1st Shift 2nd Shift 3rd Shift

Saturday 1st Shift 2nd Shift 3rd Shift

Geographic Area(s):

New Haven Branford Bridgeport West Haven East Haven Trumbull Milford Clinton Norwalk Position Applying for: Please list name/s of friends working for Marrakech: Please list name/s of relatives working for Marrakech: How did you hear about Marrakech?

Torrington

Danbury New Milford

Walk-In Word of Mouth Current Employee- Name of employee: Marrakech Website CareerBuilder/Online College/Job Fair Former Employee Marrakech Academy Another Company Social Services/CT Works Other:

Newspaper

Education
High School/G.E.D.: From: College: From: Other: From: To: Did you graduate?
YES

Proof of