Employment Application

Burlington, KS

Program, services, and employment are equally available to everyone.
Please inform the Human Resources Department if you require accommodations for the application or interview.

Full Name:

Street Address:

City:

State:

Zip Code:

Which position(s) do you have interest or experience? Check all that apply:

When are you best available to discuss job opportunities?

Mornings 8am-10:30am Afternoons 1:30pm-4pm Lunchtime 11am-1pm Evenings 6pm-9pm

Mobile:

E-Mail:

Date

Signature

Using this form:

Please complete the form as thoroughly and accurately as possible. be sure to review your application before clicking ‘send’
do NOT press ‘enter’ when changing fields, this will submit your application prematurely.
there may be latency when submitting your application. if the system appears stuck, please be patient and wait for the system to provide feedback.
Do NOT click ‘send’ more than once. this may cause a blank application to be submitted