FOR THIS TYPE OF EMPLOYMENT, STATE LAW REQUIRES A CRIMINAL RECORD CHECK AS A CONDITION OF EMPLOYMENT. We are pleased you are seeking employment with NAMI Central Georgia, Inc. Applicants with disabilities may be entitled to reasonable accommodations under the ADA and related state laws. A reasonable accommodation is a change in the way things are normally done which will ensure an equal employment opportunity without imposing an undue hardship on the company. Please contact NAMI Central Georgia at (478) 328-0508 if you need assistance completing any forms or to otherwise participate in the application process. This employment application does not create a contract or offer of employment. If hired, employment with the company will be on an at-will basis and can be terminated at the will of either you or the company. Please be advised, this application for employment is only good for 30- days from the date received by the Company. Consideration for employment after 30 days requires submission of a new application.

List all present and past employment starting with your most recent employer (last five years is sufficient). You must complete this section even if attaching a resume.

Please list three (3) individuals who are not related to you who have knowledge of your work performance and work experience, preferably former supervisors:

Please read carefully, initial each paragraph and sign at the bottom of the page.