Employment Application

Applicants are considered for all positions without regard to race, color, religion, sex, sexual orientation, national origin,
age, marital or veteran status, or the presence or a non-job-related medical condition, or handicap.

General Information

Date of Application:

Position Applied For:

Personal Information

Last Name:

First Name:

Middle Name:

Maiden Name:

Phone Number:

Email:

Address

Address:

City:

State:

Zip:

Length of time at current residence:

Have you lived at this residence for less than two years: Yes No

If yes, please explain:

Employment

Have you filled an application here before: Yes No

If yes, please give dates:

Have you been employed here before: Yes No

If yes, please give dates:

Are you employed now: Yes No

May we contact your present employer for work history and performance: Yes No

May we contact your previous employers for work history and performance: Yes No

If no, please explain:

Are you a US citizen: Yes No

If no, do you have legal rights and documents to work in the US: Yes No

What type of work are you looking for: Fulltime Part-time

Have you been convicted of a felony: Yes No

Have you been convicted of a misdemeanor: Yes No

If yes, please explain:

Hours available to work

Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

Saturday:

Sunday:

Education

Highschool

School Name:

Years Completed:

Diploma/Degree:

Course of Study:

List Specialized Training, Apprenticeship, Skills and Extra-Curricular Activities:

Honors Received:

College/University

School Name:

Years Completed:

Diploma/Degree:

Course of Study:

List Specialized Training, Apprenticeship, Skills and Extra-Curricular Activities:

Honors Received:

Graduate/Professional

School Name:

Years Completed:

Diploma/Degree:

Course of Study:

List Specialized Training, Apprenticeship, Skills and Extra-Curricular Activities:

Honors Received:

Military

Veteran of the US Military Service: Yes No

If yes, branch:

References

Give name, address and telephone number of three references who are not related to you and are not previous employers.

Reference 1

Name:

Telephone:

Years Known:

Address:

Reference 2

Name:

Telephone:

Years Known:

Address:

Reference 3

Do you have experience working with individuals with mental and/or physical disabilities: Yes No

If yes, please explain:

Special Skills and Qualifications

Summarize special skills and qualifications acquired from employment and /or other experience. If you have little or no experience Working in this field, please explain why you are interested in working with adults with developmental disabilities for MR CARES, Inc.

Rate the following in order of importance for you... Job satisfaction, Salary, Benefits, Ability to Advance in the company, Company philosophy.

Rated #1:

Rated #2:

Rated #3:

Rated #4:

Rated #5:

Applicant's Statement

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed two months. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I, the applicant, understand that neither this document nor any offer of employment from the employer constitutes an employment contract unless a specific document to that effect is executed by the employer and employee in writing. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

I UNDERSTAND THAT BY ELCTRONICALLY SIGNING THIS DOCUMENT, I CERTIFY THESE ANSWERS GIVEN HEREIN ARE TRUE AND COMPLETE AND MY ELECTRONIC SIGNATURE REPLACES MY PERSONAL SIGNATURE

Signature:

Initials:

Employment Application

Highschool

College/University

Graduate/Professional

Reference 1

Reference 2

Reference 3

Other References

Employer 1

Employer 2

Employer 3

Employer 4

Other Employment Questions

AN EQUAL OPPORTUNITY EMPLOYER A SMOKE / DRUG-FREE ENVIRONMENT

AN EQUAL OPPORTUNITY EMPLOYER
A SMOKE / DRUG-FREE ENVIRONMENT