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APPLICATION INFORMATION

Name*

First Last

Present Address*

Street Address Apt, Suite, Bldg (optional) City State Postal / Zip Code

Permanent Address

Street Address Apt, Suite, Bldg (optional) City State Postal / Zip Code

Phone*

Cell

Email*

Enter Email Confirm Email

EMPLOYMENT DESIRED

Position Applying for*

Type of Employment*

Full Time
Part Time

Date Available*

Salary Desired*

How did you hear about this position?*

Did you work for this company before?*

Yes
No

If so, what department:

Are you employed now?*

Yes
No

May we contact any or all present/past employers?*

Yes
No

EDUCATION

HIGH SCHOOL

High School Name & Location*

Years Attended*

Did you graduate*

Yes
No

COLLEGE

College Name & Location

Years Attended

Did you graduate

Yes
No

Subjects Studied

TRADE OR TECH SCHOOL

Trade or Tech School Name & Location

Years Attended

Did you graduate

Yes
No

Subjects Studied

MILITARY

U.S. Military

Yes
No

Rank

Presently in National Guard or Reserve

FORMER EMPLOYERS

List below your last four (4) employers starting with the most recent one first. Click the + button to add additional employers

COMPANY

Name of Company

Phone

Name of Supervisor

Address

Street Address Apt, Suite, Bldg (optional) City State Postal / Zip Code

From Date

To Date

Salary

Position

Reason for Leaving

REFERENCES

Give the names of at least three (3) persons not related to you who you have known at least one year. Click the + button to add more references.

REFERENCE

Name

Phone

Company / Position

Years Known

Upload Resume

Upload your resume (pdf, doc, or docx only)

Background Information

Have you ever pleaded guilty to or been convicted of a misdemeanor, felony, or ordinance violation or other offense (including military court-martials)?*

You may exclude minor traffic convictions such as speeding or parking tickets. *

No
Yes (please explain below)

Are you subject to any pending criminal charges?*

No
Yes (please explain below)

Please Explain

If you answered yes to either of the above, provide further information as to the offense(s), date, location of court, etc. A yes answer is not an automatic bar to employment. The Arc Greater Columbia County will consider your record only as it may substantially relate to the position applied for, or as otherwise permitted by law.

MISCELLANEOUS INFORMATION

If hired can you verify your legal rights to work in the U.S. by providing a Birth Certificate, Proof of U.S. Citizenship or by other means?*

Yes
No

PLEASE READ CAREFULLY BEFORE SIGNING THIS FORM

I authorize investigation of the reference listed above to give The Arc Greater Columbia County, INC. any and all information concerning my current/previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

Upon a job offer from The Arc Greater Columbia County, INC. and at any time during my employment I authorize The Arc Greater Columbia County, INC. to obtain an investigative consumer reports that may include but not limited to a criminal records checks and driving records. The Arc Greater Columbia County, INC. further requires pre-employment drug screening.

* I certify that, to the best of my knowledge and belief, the answers given by me to the foregoing questions and the statements made by me in this application are correct and complete. I understand that misrepresentation or omission of facts in this application may result in my discharge. If employed, I understand and agree that such employment may be terminated at any time, without prior notice, and that my employment will not be governed by an expressed or implied contact but is at-will. I hereby give the employer the right to investigate all references unless otherwise stated herein.

AUTHORIZATION TO RELEASE WAGE AND EMPLOYMENT INFORMATION

I hereby authorize my current/former employers to release employment information to The Arc Greater Columbia County. Employment history, wages and any information which may be requested relative to my employment, employment applications, and other related matters. The foregoing authorization shall continue in force until revoked by me in writing. A photocopy of this information shall have the same force and effect as the original.

I further release my current/former employers from any and all liability of any kind for releasing any employment information.

Signature*

Verification

Application for Employment

APPLICATION INFORMATION

EMPLOYMENT DESIRED

EDUCATION

HIGH SCHOOL

COLLEGE

TRADE OR TECH SCHOOL

MILITARY

FORMER EMPLOYERS

COMPANY

REFERENCES

REFERENCE

Upload Resume

Background Information

MISCELLANEOUS INFORMATION