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McDowell County Commission on Aging Employment Application

Step 1 of 4

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Personal Information
Date*
MM slash DD slash YYYY
Name*
First Middle Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
Are you 18 years or older?*
- Yes
- No
Are you either a U.S. citizen or an alien authorized to work in the United States?*
- Yes
- No

Employment Desired
Location applying to:
Position*
Date you can start?*
MM slash DD slash YYYY
Salary desired*
Are you employed now?*
- Yes
- No
May we inquire of your present employer?*
- Yes
- No
Ever applied to this company before?*
- Yes
- No
Where?*
- Yes
- No
When?*
- Yes
- No
Referred by

Education
Name of High School:
Location of High School:
Number of years attended - High School:
Did you graduate High School?
- Yes
- No
High School subjects studied:
Name of college or trade/business school:
Location of college or trade/business school:
Number of Years Attended - college or trade/business school:
Did you graduate college or trade/business school?
- Yes
- No
College or trade/business school subjects studied:

General
Subjects of special study or research work?
Special skills?
Activities (Civic, athletic, etc.)?
Do not include organizations which indicate race, religion, sex, age, marital status or nation of origin of its members.
Military service?
- Yes
- No
Rank?
Active?
- Yes
- No
Discharge date?
MM slash DD slash YYYY

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						Contact Us

Welch 
 Senior Center Facility
							725 Stewart Street 

							Welch, WV  24801
						
							Phone: (304) 436-6588
						
							Fax: (304) 436-2006
						
							Email: donald@mcdowellcoa.org						
Bradshaw 
 Senior Center Facility
							10162 Marshall Highway 

							Bradshaw, WV 24817
						
							Phone: (304) 967-5472
						
							Fax: (304) 967-5472
						
							Email: nutrition@mcdowellcoa.org						
Office Hours 
 Contact our main office

							Monday: 7:30 a.m – 4:00 p.m. 

							Tuesday: 7:30 a.m – 4:00 p.m. 

							Wednesday: 7:30 a.m – 4:00 p.m. 

							Thursday: 7:30 a.m – 4:00 p.m. 

							Friday: 7:30 a.m – 4:00 p.m. 

							Saturday & Sunday: Closed
						
							After Hours Answering Service for Clients or Emergencies: 304-589-0226