• Please PRINT all information requested and sign the application. You may attach your resume; however, it is not a substitute for the completed application form. Collaborative Solutions for Communities formerly known as Columbia Heights/Shaw Family Support Collaborative is an Equal Opportunity Employer operating a Drug-Free Workplace. A post-offer, negative drug test is required as a condition of hire.

Personal Data


Employment History

    Employer #1

  • Employer #2

  • Employer #3

  • Employer #4



  • REFERENCES: Please list at least three references that are not related to you. These references should include at least one if not two former supervisors and someone whom you managed or who was a co-worker with you:
  • Reference 1

  • Reference 2

  • Reference 3



  • In exchange for the consideration of my job application with Collaborative Solutions for Communities (CSC), I agree that: Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other CSC practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of CSC or otherwise to change in any respect the “employment-at-will” relationship between CSC and the undersigned, and that relationship cannot be altered except by a written instrument signed by the Executive Director of CSC. Both the undersigned and CSC may end the employment relationship at any time, without specified notice or reason. If employed, I understand that CSC may unilaterally change or revise its benefits, policies and procedures and such changes may include reduction in staff and/or benefits. I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give CSC permission to contact schools, previous employers (unless otherwise indicated), references and others. I further authorize the company to complete a criminal background check. I hereby release CSC from any liability as a result of such contacts, inquiries, or records in order to ascertain my qualifications and fitness for employment. I further understand that my employment with CSC shall be considered introductory for a period of one hundred-twenty (120) days and further that at any time during the introductory period or thereafter, my employment relationship with CSC is terminable “at will” for any reason by either party. CSC is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, national origin, age, physical or mental handicap, or sexual orientation. We assure you that your opportunity for employment with CSC depends solely on your qualifications. I further understand that CSC requires a negative drug test following any offer of employment and thereafter conducts random and/or reasonable suspicion drug tests through the course of employment. Thank you for completing this application for and for your interest in CSC.