This document is an employment application for Side by Side II, Inc. It requests personal information from applicants such as name, address, phone numbers, and availability. It also asks for education history, employment history with duties and supervisor contact information, and relevant skills or certifications. The application notes the company's equal opportunity policies and commitment to non-discrimination. It requires initials from applicants to acknowledge understanding of the company's policies on drug testing, at-will employment, and background checks.
Application form for employment (đơn xin việc tiếng anh)Học Huỳnh Bá
This document is an application for employment. It collects personal information such as contact details, citizenship and authorization to work status, availability, willingness to work different shifts, felony history, education history and skills. It also requests employment history, references, emergency contacts and requires the applicant to authorize the potential employer to verify the information provided and contact references and previous employers. It specifies that employment would be at-will.
This document is an application for employment at The Point Crab House and Grill. It requests basic personal information from applicants such as name, address, and availability. It also asks about an applicant's education history, work experience, skills, criminal record, and availability to work in terms of hours and shifts. The application notes that the establishment considers all applicants equally regardless of personal characteristics. It includes an authorization for background checks and at-will employment agreement stating that either party can end the employment at any time.
This document is a job application for Domino's Pizza. It requests basic personal information like name, address, phone number, and availability. It also asks about the applicant's education history, previous work experience including any previous work at Domino's, driving record, and criminal history to evaluate eligibility. The application emphasizes that Domino's is committed to diversity and creating an inclusive work environment.
This document is a standard job application that collects personal and employment information from applicants. It notes that the employer complies with equal opportunity laws and requires applicants to fully complete the application. It requests contact details, availability, authorization to work, education history, skills, references, employment history and availability of former employers as references. The applicant verifies the accuracy of the information and acknowledges the employer's "at-will" employment terms.
This document is an application for employment at Lincourt Manor Inc. It begins with a statement that the Human Rights Codes prohibit discrimination in hiring based on several personal characteristics.
The application requests personal information from the applicant such as name, address, availability, education history, work experience, references, and certification that the information provided is true. It notes that falsified information is grounds for dismissal.
If hired, additional personal information may be requested for benefit programs, national security compliance, or other legally permitted reasons. The application concludes by stating that hiring will be based solely on merit and that the applicant will be notified in case of an emergency.
This document is an application for employment that requests personal information such as name, address, and contact details. It asks for employment history including current employer information if applicable. The application also inquires about education, references, and includes a certification and signature line for the applicant.
The applicant is applying for a position with the State of Texas. The application requests standard employment information such as name, contact details, education history, employment history, military service, and availability. It notes that the State of Texas is an equal opportunity employer and does not discriminate. The applicant must sign to confirm the accuracy of the information provided and authorize references to be contacted.
Application form for employment (đơn xin việc tiếng anh)Học Huỳnh Bá
This document is an application for employment. It collects personal information such as contact details, citizenship and authorization to work status, availability, willingness to work different shifts, felony history, education history and skills. It also requests employment history, references, emergency contacts and requires the applicant to authorize the potential employer to verify the information provided and contact references and previous employers. It specifies that employment would be at-will.
This document is an application for employment at The Point Crab House and Grill. It requests basic personal information from applicants such as name, address, and availability. It also asks about an applicant's education history, work experience, skills, criminal record, and availability to work in terms of hours and shifts. The application notes that the establishment considers all applicants equally regardless of personal characteristics. It includes an authorization for background checks and at-will employment agreement stating that either party can end the employment at any time.
This document is a job application for Domino's Pizza. It requests basic personal information like name, address, phone number, and availability. It also asks about the applicant's education history, previous work experience including any previous work at Domino's, driving record, and criminal history to evaluate eligibility. The application emphasizes that Domino's is committed to diversity and creating an inclusive work environment.
This document is a standard job application that collects personal and employment information from applicants. It notes that the employer complies with equal opportunity laws and requires applicants to fully complete the application. It requests contact details, availability, authorization to work, education history, skills, references, employment history and availability of former employers as references. The applicant verifies the accuracy of the information and acknowledges the employer's "at-will" employment terms.
This document is an application for employment at Lincourt Manor Inc. It begins with a statement that the Human Rights Codes prohibit discrimination in hiring based on several personal characteristics.
The application requests personal information from the applicant such as name, address, availability, education history, work experience, references, and certification that the information provided is true. It notes that falsified information is grounds for dismissal.
If hired, additional personal information may be requested for benefit programs, national security compliance, or other legally permitted reasons. The application concludes by stating that hiring will be based solely on merit and that the applicant will be notified in case of an emergency.
This document is an application for employment that requests personal information such as name, address, and contact details. It asks for employment history including current employer information if applicable. The application also inquires about education, references, and includes a certification and signature line for the applicant.
The applicant is applying for a position with the State of Texas. The application requests standard employment information such as name, contact details, education history, employment history, military service, and availability. It notes that the State of Texas is an equal opportunity employer and does not discriminate. The applicant must sign to confirm the accuracy of the information provided and authorize references to be contacted.
This document contains an employment application for Lightning Energy Services, LLC. It requests basic applicant information like contact details, position applying for, availability, and authorization to work. It also contains sections to list prior work experience, education, references, and requires the applicant's signature agreeing to the terms of the application and authorizing background checks.
The document provides instructions for submitting an online application for employment with ECM Energy Services Inc. It states that after filling out the application, the applicant should click the "Submit Application" button, which will open their default email program with the application attached. They should then send the email to jobs@ecmenergy.com. The document notes that the company will contact qualified applicants whose qualifications meet their needs.
This document is an application form for allotment of a Permanent Account Number (PAN) in India. It requests individual/entity details such as name, gender, date of birth/incorporation, address, father's name, photograph, income sources, and documents for identity, address and date of birth proof. Instructions are provided on accurately filling name fields like using full names without abbreviations, and address details like country/PIN codes. Applicants are advised to provide contact details and Aadhaar/Enrolment ID number as per Indian tax laws.
This document provides instructions for new and transfer students to complete their online housing contract and request form for the Fall 2011 semester at SUNY Delhi. It outlines the two required steps: 1) Paying a $100 housing deposit and 2) Completing the online form. It provides detailed guidance on navigating the form, including how to request roommates, rank housing preferences, and sign the binding housing contract.
The document appears to be an application for a work study program with Toledo Public Schools. It requests personal information such as name, address, social security number, and availability. It also asks about the applicant's educational and employment history. Additionally, it inquires about salary requirements and includes tips for completing the application and interviewing successfully.
The document appears to be an application for a work study program with Toledo Public Schools. It requests personal information such as name, address, social security number, and availability. It also asks about the applicant's educational and employment history. Additionally, it requests salary requirements and certification that the information provided is true. Suggestions are given for completing the application successfully and preparing for an interview.
This document is a job application form requesting personal and employment details. It collects information such as name, address, contact details, education history, languages spoken, employment history including positions held and salaries, reasons for leaving jobs, job preferences, computer skills, references, and a signature agreeing to the terms of the application. Health information and any criminal history are also requested.
This document is a request form for a new PAN card or changes/corrections to an existing PAN card. It requests information such as the applicant's name, date of birth, gender, address, phone number, email, and Aadhaar number. It provides instructions on how to fill out the form correctly, such as writing the applicant's full name without abbreviations, providing the father's name for individual applicants, and including country and area codes for phone numbers. The applicant must sign and date the form and may submit supporting documents for proposed changes.
This document contains a personal history form for employment with the United Nations. The form requests biographical information such as name, date of birth, citizenship, education history, employment history, languages, and references. It informs applicants that entry into UN service may require worldwide travel and asks about any disabilities. It also certifies that all information provided is true and understands misrepresentation can result in termination.
The document is an application form for permanent residence in Singapore. It requests information about the applicant such as personal details, education history, employment history, family details, and other supporting documents. If approved, it would grant the applicant an Entry Permit to live in Singapore permanently. The form consists of several parts requesting details about the applicant, applicant's spouse and children, previous marriages, declaration of truth of details, and consent for authorities to verify the information provided. Signatures are required from the applicant and spouse (if applying). Photocopies of identification documents like passports and birth certificates for applicant and family are also required to be submitted along with the form.
The document is an application form for permanent residence in Singapore for professionals, technical personnel, and skilled workers. It requests information such as the applicant's personal details, nationality, education history, employment history, salary, and residential address in Singapore. The form notifies that it may take 20 minutes to complete and must include a recent passport photo of the applicant.
Candidate Application and Background check sheetAllen Shaw
This document is an employment application for MedSearch Corp, a medical staffing agency. It requests personal information such as name, address, education history, employment history, references, and includes legal disclosures for background checks. The applicant is asked to provide details on their qualifications, sign disclosures allowing reference and background checks, and agrees the information provided is true.
To apply for a store position at Dollar General, applicants must fill out and print the application forms, which include sections on personal information, employment history, education, references, and a notification and agreement. They should then return the completed application to the store where they are applying. The document notes that background checks and drug tests may be required.
This document is an application for employment with the Georgia Department of Defense. It requests personal information, employment eligibility details, education history, language skills, professional licenses, a detailed work history for the past 10 years, military service details if applicable, and optional equal employment opportunity information. Applicants must certify that the information provided is true and accurate, and understand that intentionally providing false information would be a violation of state law.
This document is an application for employment at Balfurd, an equal opportunity employer. It requests personal information such as name, address, phone numbers, availability, and willingness to relocate or travel. It asks about prior employment history with the company, legal authorization to work, and ability to perform job functions. Educational background and driving record are also requested. Work history for the past 10 years is to be detailed. Military service information is collected. The applicant signs to affirm the information and that they understand the company's equal opportunity policies.
This document is an application for employment at Balfurd, an equal opportunity employer. It requests personal information such as name, address, phone number, and availability. It asks about the position applied for and willingness to relocate or travel. It inquires about past employment, including at Balfurd or its subsidiaries. It also asks about the applicant's ability to legally work in the US and any convictions. Further sections address job function abilities, education history, driving record if a vehicle is required, work history for the past 10 years, and military service. The applicant must sign and date to complete the application.
This document is an application for employment at Domino's Pizza. It requests basic personal information such as name, address, phone number, and availability. It also asks about the applicant's education history, previous work experience including any previous work at Domino's, driving record, and background/criminal history. The applicant is asked to sign consenting to a background check if hired and certifying that the information provided is truthful. State-specific notices provide additional disclosures about applicant rights.
This document is a job application for Domino's Pizza. It requests basic personal information like name, address, phone number, and availability. It also asks about the applicant's education history, previous work experience including any previous work at Domino's, driving record, and criminal history to evaluate eligibility. The application emphasizes that Domino's is committed to diversity and creating an inclusive work environment.
This document contains an application for volunteer positions at Hope Aglow Empowerment Center. It includes sections for listing skills and courses, a certification and release stating the applicant understands misrepresentation can lead to dismissal, and that the volunteer relationship can be terminated at any time. The applicant also agrees to follow all safety regulations. By signing, the applicant certifies all information is true to the best of their knowledge.
This document is an application form for a position with Sutton Coldfield Dairies. It requests personal details, education and employment history, references, and availability for an interview. It also notes that a background check including criminal record check will be conducted as part of the hiring process due to the nature of the dairy business. The applicant is asked to provide thorough details to account for the past 10 years. Debts, bankruptcies, and legal judgments are also addressed. The final page includes interview notes fields.
The document is an employment application for a healthcare position. It requests personal information like name, address, education history, skills, and availability. It also asks about prior work experience, licensing and certifications, driving record, background check, drug testing policy, and availability. The applicant must agree to abide by company policies on prescription drug use, smoking, and authorizes the employer to investigate the application details and contact references.
This document contains an employment application for Lightning Energy Services, LLC. It requests basic applicant information like contact details, position applying for, availability, and authorization to work. It also contains sections to list prior work experience, education, references, and requires the applicant's signature agreeing to the terms of the application and authorizing background checks.
The document provides instructions for submitting an online application for employment with ECM Energy Services Inc. It states that after filling out the application, the applicant should click the "Submit Application" button, which will open their default email program with the application attached. They should then send the email to jobs@ecmenergy.com. The document notes that the company will contact qualified applicants whose qualifications meet their needs.
This document is an application form for allotment of a Permanent Account Number (PAN) in India. It requests individual/entity details such as name, gender, date of birth/incorporation, address, father's name, photograph, income sources, and documents for identity, address and date of birth proof. Instructions are provided on accurately filling name fields like using full names without abbreviations, and address details like country/PIN codes. Applicants are advised to provide contact details and Aadhaar/Enrolment ID number as per Indian tax laws.
This document provides instructions for new and transfer students to complete their online housing contract and request form for the Fall 2011 semester at SUNY Delhi. It outlines the two required steps: 1) Paying a $100 housing deposit and 2) Completing the online form. It provides detailed guidance on navigating the form, including how to request roommates, rank housing preferences, and sign the binding housing contract.
The document appears to be an application for a work study program with Toledo Public Schools. It requests personal information such as name, address, social security number, and availability. It also asks about the applicant's educational and employment history. Additionally, it inquires about salary requirements and includes tips for completing the application and interviewing successfully.
The document appears to be an application for a work study program with Toledo Public Schools. It requests personal information such as name, address, social security number, and availability. It also asks about the applicant's educational and employment history. Additionally, it requests salary requirements and certification that the information provided is true. Suggestions are given for completing the application successfully and preparing for an interview.
This document is a job application form requesting personal and employment details. It collects information such as name, address, contact details, education history, languages spoken, employment history including positions held and salaries, reasons for leaving jobs, job preferences, computer skills, references, and a signature agreeing to the terms of the application. Health information and any criminal history are also requested.
This document is a request form for a new PAN card or changes/corrections to an existing PAN card. It requests information such as the applicant's name, date of birth, gender, address, phone number, email, and Aadhaar number. It provides instructions on how to fill out the form correctly, such as writing the applicant's full name without abbreviations, providing the father's name for individual applicants, and including country and area codes for phone numbers. The applicant must sign and date the form and may submit supporting documents for proposed changes.
This document contains a personal history form for employment with the United Nations. The form requests biographical information such as name, date of birth, citizenship, education history, employment history, languages, and references. It informs applicants that entry into UN service may require worldwide travel and asks about any disabilities. It also certifies that all information provided is true and understands misrepresentation can result in termination.
The document is an application form for permanent residence in Singapore. It requests information about the applicant such as personal details, education history, employment history, family details, and other supporting documents. If approved, it would grant the applicant an Entry Permit to live in Singapore permanently. The form consists of several parts requesting details about the applicant, applicant's spouse and children, previous marriages, declaration of truth of details, and consent for authorities to verify the information provided. Signatures are required from the applicant and spouse (if applying). Photocopies of identification documents like passports and birth certificates for applicant and family are also required to be submitted along with the form.
The document is an application form for permanent residence in Singapore for professionals, technical personnel, and skilled workers. It requests information such as the applicant's personal details, nationality, education history, employment history, salary, and residential address in Singapore. The form notifies that it may take 20 minutes to complete and must include a recent passport photo of the applicant.
Candidate Application and Background check sheetAllen Shaw
This document is an employment application for MedSearch Corp, a medical staffing agency. It requests personal information such as name, address, education history, employment history, references, and includes legal disclosures for background checks. The applicant is asked to provide details on their qualifications, sign disclosures allowing reference and background checks, and agrees the information provided is true.
To apply for a store position at Dollar General, applicants must fill out and print the application forms, which include sections on personal information, employment history, education, references, and a notification and agreement. They should then return the completed application to the store where they are applying. The document notes that background checks and drug tests may be required.
This document is an application for employment with the Georgia Department of Defense. It requests personal information, employment eligibility details, education history, language skills, professional licenses, a detailed work history for the past 10 years, military service details if applicable, and optional equal employment opportunity information. Applicants must certify that the information provided is true and accurate, and understand that intentionally providing false information would be a violation of state law.
This document is an application for employment at Balfurd, an equal opportunity employer. It requests personal information such as name, address, phone numbers, availability, and willingness to relocate or travel. It asks about prior employment history with the company, legal authorization to work, and ability to perform job functions. Educational background and driving record are also requested. Work history for the past 10 years is to be detailed. Military service information is collected. The applicant signs to affirm the information and that they understand the company's equal opportunity policies.
This document is an application for employment at Balfurd, an equal opportunity employer. It requests personal information such as name, address, phone number, and availability. It asks about the position applied for and willingness to relocate or travel. It inquires about past employment, including at Balfurd or its subsidiaries. It also asks about the applicant's ability to legally work in the US and any convictions. Further sections address job function abilities, education history, driving record if a vehicle is required, work history for the past 10 years, and military service. The applicant must sign and date to complete the application.
This document is an application for employment at Domino's Pizza. It requests basic personal information such as name, address, phone number, and availability. It also asks about the applicant's education history, previous work experience including any previous work at Domino's, driving record, and background/criminal history. The applicant is asked to sign consenting to a background check if hired and certifying that the information provided is truthful. State-specific notices provide additional disclosures about applicant rights.
This document is a job application for Domino's Pizza. It requests basic personal information like name, address, phone number, and availability. It also asks about the applicant's education history, previous work experience including any previous work at Domino's, driving record, and criminal history to evaluate eligibility. The application emphasizes that Domino's is committed to diversity and creating an inclusive work environment.
This document contains an application for volunteer positions at Hope Aglow Empowerment Center. It includes sections for listing skills and courses, a certification and release stating the applicant understands misrepresentation can lead to dismissal, and that the volunteer relationship can be terminated at any time. The applicant also agrees to follow all safety regulations. By signing, the applicant certifies all information is true to the best of their knowledge.
This document is an application form for a position with Sutton Coldfield Dairies. It requests personal details, education and employment history, references, and availability for an interview. It also notes that a background check including criminal record check will be conducted as part of the hiring process due to the nature of the dairy business. The applicant is asked to provide thorough details to account for the past 10 years. Debts, bankruptcies, and legal judgments are also addressed. The final page includes interview notes fields.
The document is an employment application for a healthcare position. It requests personal information like name, address, education history, skills, and availability. It also asks about prior work experience, licensing and certifications, driving record, background check, drug testing policy, and availability. The applicant must agree to abide by company policies on prescription drug use, smoking, and authorizes the employer to investigate the application details and contact references.
This document contains an employment application form seeking personal information, availability, education history, and previous work experience from a potential job applicant. If hired, the applicant would be informed that their personal information would be used for payroll administration and benefits and may be shared with third parties. The applicant is asked to consent to pre-employment screening and agree that employment can be terminated at any time by either party.
Planned Parenthood is an equal opportunity employer that does not discriminate in hiring or employment. The application requests basic personal information such as name, address, phone number, and eligibility to work. It asks about the applicant's education history, previous work experience, licenses or certifications, and personal references. By signing, the applicant authorizes Planned Parenthood to conduct background checks and acknowledges that providing false information is grounds for disqualification or dismissal.
The document provides worksheets and guidance to help job seekers prepare for interviews. It outlines steps one should take, such as researching the company, dressing appropriately, and following up with a thank you note. It also lists things to avoid, like being late, acting entitled, or speaking negatively about previous employers. The document aims to help job seekers understand what interviewers look for in candidates and how to make the best possible impression.
This document is an employment application that collects personal and job-related information from applicants. It requests contact details, education history, employment history including past positions and salaries, availability, and professional references. The applicant is asked to disclose any prior felony convictions and sign to acknowledge the truth and completeness of the application, with notice that false information could result in dismissal.
The document is an exit interview form for an employee leaving Company ABC in Pakistan. It collects information about the employee's reasons for leaving, what they liked and disliked about their job, whether they would consider returning, and their assessment of benefits, workplace relationships, and job satisfaction at the company. The form asks the employee to rate these areas as excellent, good, average, poor, or no opinion. It concludes by asking for any other suggestions for improvement and signatures from the employee and their manager.
The document is an employment application for New York State. It begins by stating that NYS is an equal opportunity employer and prohibits discrimination of any kind. It requests contact information from applicants who require accommodations. The application instructs applicants to complete all pages and sections, and may be required to submit additional materials. It requests information about eligibility to work, driver's license, education history, employment history, availability, and professional references.
This document is a student application form for a 3-day IT summer school program taking place from July 17-19, 2012 at the University of Greenwich. [END SUMMARY]
The document appears to be an interview evaluation form for assessing candidates for job positions, with criteria rated on scales for qualities like personality, communication skills, job knowledge, and recommendations on whether the candidate should be hired or have a follow up interview. It also includes sections to record the candidate's employment history, expected and offered salary and benefits if hired.
Hrd Form 24 Personal Data Job ApplicationConfidential
The document is an employment application for AALAT L.L.C. It requests information such as the applicant's name, address, phone number, availability, education history, employment history including previous positions and dates of employment, references, and a signature agreeing the information provided is true. The application gathers information needed to evaluate candidates for employment.
This document is a lengthy application form for a nursing position. It requests personal details, contact information, addresses, qualifications, employment history, references, health declarations, and notes. It informs the applicant that incomplete forms will be returned, and that the agency will need to process personal data for safety and suitability assessments. The applicant must sign declaring the information is accurate and agreeing to the data processing before returning the completed form.
Parent Teacher Conference Form PrimaryRendra S.Sos
This document is a primary parent-teacher conference form for Peek A Boo & Vision School. It requests information from parents about their child's personal details, family, home life, strengths/weaknesses, independence, interests, medical conditions, and goals for development. The form notes that all information provided will remain strictly confidential. Parents are asked to fill it out completely to help teachers understand how best to serve their child.
This document is an employment application for an hourly position at Outback Steakhouse. It requests basic personal information from applicants such as name, address, availability, and desired pay rate. It also asks questions to assess qualifications for various restaurant roles and whether applicants can comply with job requirements like lifting, standing for long periods, and flexible scheduling. Applicants must confirm they are legally authorized to work and will abide by company policies regarding appearance, smoking, and drug use. Work history and references are also requested.
This document is an employment application for an hourly position at Outback Steakhouse. It requests basic personal information from applicants such as name, address, availability, and desired pay rate. It also asks questions to assess qualifications for various restaurant roles and whether applicants can comply with job requirements like lifting, standing for long periods, and flexible scheduling. Applicants must confirm they are legally authorized to work and will abide by company policies regarding appearance, smoking, and drug use. Work history and references are also requested.
1. SIDE BY SIDE II, Inc., EMPLOYMENT APPLICATION
Personal Information
Name (Last, First, MI)
Last Name, First Initial:
Street Address
City, State, Zip
Home Phone Number Work Phone Number
Cell Phone Number E-mail Address
Social Security Number Driver’s License number/state/expiration
Employment Desired
Position applied for
How did you hear about this position?
Date available for work Desired Hours (full-time, part-time, etc.)
Education
Name and address of School Course of Study Total Years of Degree/
Study Diploma
High School
Today’s Date:
Undergraduat
e College
Graduate/
Professional
Other
(specify)
Can you provide proof of a high school diploma or a G.E.D Yes No not sure
List any seminars, classes or other education not listed above which may help qualify you for this
position (if you need additional space, please attach):
1
2. EMPLOYMENT APPLICATION
Employment History
Below, list all present and past employers over the past ten years, starting with your most recent employer.
Account for all periods of unemployment. You must complete this section even if attaching a resume. May we
contact your current employer? Yes No
Employer (current Yes No) Start Date End Date Essential job functions of final position
Address 1.
City, State, Zip Starting Ending 2.
Salary Salary
Phone Number 3.
Cell Phone Number Job Position (s) 4.
Supervisor (s) Supervisor’s Phone/Email
Reason (s) for leaving
Employer (current Yes No) Start Date End Date Essential job functions of final position
Address 1.
City, State, Zip Starting Ending 2.
Salary Salary
Phone Number 3.
Cell Phone Number Job Position (s) 4.
Supervisor (s) Supervisor’s Phone/Email
Reason (s) for leaving
Identify any
formal job _____________________________________________________________________________
training, _____________________________________________________________________________
skills or _____________________________________________________________________________
certifications _____________________________________________________________________________
you possess
that relates to
this position:
2
3. EMPLOYMENT APPLICATION
Additional Information
Have you ever been employed with this company before? Yes No
If yes, when? ______________________________________________________________________________
Do you have any friends or relatives employed by this company? Yes No
If yes, please provide their names and relationship to you: __________________________________________
__________________________________________________________________________________________
Are you currently employed? Yes No
May we contact your employer? Yes No
Are you currently on “lay off” status and subject to recall? Yes No
Are you at least 18 years of age? Yes No
If hired, can you provide proof of U.S. citizenship or proof of your Yes No
legal right to work in the U.S.?
Are you able to perform all of the essential functions of the job Yes No
for which you are applying with or without reasonable accommodations?
________________________________________________________________________________________
________________________________________________________________________________________
If hired, are there any accommodations the company would need to Yes No
provide so that you can perform all those essential functions and duties
of the position being applied for?
If yes, please explain: ________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
If driving is a requirement of the position applied for, have you in the last N Yes F No
7 years been convicted of Driving Under the Influence “(DUI)”? N/A
If hired, do you have a reliable means of transportation to and from work? Yes No
Have you ever been convicted of a felony? Yes No
If yes, please explain: ________________________________________________________________________
__________________________________________________________________________________________
As far as you know, is there anything that might come up on your A Yes N No
background check that might disqualify you for this position?
A criminal record does not constitute an automatic bar to employment and will be considered only as it substantially relates to the job in
question. All applicants must register with the Family Care Registry. A background check will be conducted and certain convictions
may disqualify you for employment in this field.
Can you provide proof of a valid driver’s license? CYes f No r Not right now
Can you provide proof of auto insurance? CYes f No e not right now
Can you provide proof of a social security card? Yes o No u not right now
Can you provide proof of the following trainings/certificates?
Medication Aide M Yes expiration date: _______________ / No
Abuse/Neglect A Yes expiration date: _______________ / No
Bloodborne Pathogens Yes expiration date: _______________ / No
CPR Yes expiration date: _______________ i
First Aid Yes expiration date: _______________ i
Positive Behavior Supports
3
4. EMPLOYMENT APPLICATION
Additional Information
Please check the most appropriate answer:
MRDD 2+ years of experience e 1 -2 years of experience < 1 year experience r limited or no experience
Sign Language a 2+ years of experience o 1 -2 years of experience < 1 year experience
limited or no experience
Autism s 2+ years of experience 1 -2 years of experience < 1 year experience e limited or no experience
Children w/ disabilities d 2+ years of experience 1 -2 years of experience < 1 year experience
limited or no experience
Physical Disabilities a 2+ years of experience 1 1 -2 years of experience < 1 year experience
limited or no experience
Experience w/ Bowel Cleanup e 2+ years of experience 1 1 -2 years of experience < 1 year experience
limited or no experience
Feces Smearing m 2+ years of experience 1 -2 years of experience < 1 year experience
limited or no experience
Verbal Aggression A 2+ years of experience 1 -2 years of experience < 1 year experience
limited or no experience
Physical Aggression l 2+ years of experience 1 -2 years of experience < 1 year experience
limited or no experience
Sexual Inappropriateness I 2+ years of experience 1 -2 years of experience < 1 year experience
limited or no experience
Non Verbal Communication b 2+ years of experience 1 -2 years of experience < 1 year experience
limited or no experience
If you had to choose, would you prefer to work with someone who was total care and little behavioral issues or with someone who was
more independent but has behavioral challenges? Please Explain ____________________________
________________________________________________________________________________________________
Please read each statement closely and initial each acknowledging your understanding
Equal Employment Opportunity Statement
This company is committed to the principles of equal employment opportunity and is committed to make employment decisions based on merit. We are committed to
complying with all Federal, State, and local laws providing for equal employment opportunities, as well as all laws related to terms and conditions of employment.
The Company desires to maintain a work environment that is free of sexual harassment and discrimination due to race, religion, color, national origin, physical or
mental disability, age, or any other status protected by Federal, State, or Local laws. The Company will make reasonable efforts to accommodate those physical or
mental limitations of an otherwise qualified employee unless undue hardship would result for the company
Please Initial: _______
Discrimination and Sexual Harassment Policy Statement
This Company will not tolerate any form of unlawful discrimination, including sexual harassment. Any employee who engages in unlawful discrimination or sexual
harassment will be subject to appropriate discipline, up to and including termination. Prohibited sexual harassment is defined as follows: Unwelcome sexual
advances, requests for sexual favors and other verbal or physical conduct of a sexual nature constitutes sexual harassment when (1) submission to such conduct is
made whether explicitly or implicitly a term or condition of an individual’s employment; (2) Submission to or action of such conduct by an individual is used as the
basis for employment decisions affecting such individuals; (3) Such conduct has the purpose or effect of unreasonably interfering with an individual’s work
performance or creating an intimidating, hostile or offensive work environment.
Please Initial: _______
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5. Disclosure to Applicants Concerning Drug/Alcohol Testing
If you are offered a position with the Company, you may be given a drug/alcohol test as a condition of employment. Your refusal to timely submit to a drug/alcohol
test or your failure to pass such a test means you will not be employed by this Company. Neither the collector of specimens nor the medical professional who
reviews the test results will be a Company employee. The test results will be kept confidential. The individual undergoing testing will not be directly observed while
providing the specimen unless there are reasonable grounds to believe the individual may alter or substitute the specimen. Negative test results are required as a
condition of employment.
Please Initial: _______
Complete and Accurate Information
I herby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true
and correct to the best of my knowledge. I further certify that I have personally completed this application. I understand that any omission or misstatement of
material fact on this application, or any other document used to secure employment, shall be grounds for rejection of this application or for immediate discharge if I
am employed, regardless of the time elapsed before discover.
Please Initial: _______
At Will Employment
______ I understand and agree that if I am employed, my employment will be “at-will,” which means that the Company may terminate the employment relationship
at any time, with or without cause and with or without notice. Likewise, the Company will respect my right to terminate my employment at any time, with or without
cause and with or without notice. I further understand that any prior
representation, whether expressed or implied to the contrary is hereby superseded and that no promise or representation contrary to the foregoing is binding on the
Company unless made in writing and signed by the Company’s president.
Testing Authorization
______ If offered a position with the Company, I hereby agree to any legally permitted physical, psychological, skill, drug or medical test required by the Company
as a condition of employment.
Investigation Authorization
______ I authorize investigation into all statements and references contained in this application. Said investigation may include credit, driving, criminal background,
references and other background checks. By applying for this job, I also authorize post-hire investigation into my credit, driving and criminal background.
Company Obligation
______ I understand and agree that the Company’s acceptance of this job application does not mean that a position for which I am qualified is open (unless
specifically posted) or that the Company has agreed to hire me. I understand that the Company is under no obligation to hire me as the result of accepting this
completed application.
I HAVE READ AND UNDERSTAND THE ABOVE POLICY STATEMENTS
AND AGREE TO BE BOUND BY THEM IF EMPLOYED BY THE COMPANY.
_______________________________ __________________
Signature Date
Side By Side is an equal opportunity employer
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