Employment Application

Name*
First Last
Middle Initial
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Enter Email Confirm Email
Date Available*
Desired Salary $:*
Position Applied for:*
Which Program(s):*
Status Desired:*
Are you available to work weekends?*
Are there any hours or days that you would not be willing to work?*
Please specify:*
Do you have any relatives who work for Arc?*
Which Program?*
Are you currently employed?*
May we contact your present employer?*
Have you applied to The Arc before?*
When?*
Have you worked for The Arc before?*
From:*
To:*
Reason for leaving the Arc:*
Name of last supervisor at The Arc:*
First Last
Are you authorized to work in the U.S.?*
Have you ever been convicted of a crime?*
Explain:*
Have you received a DUI within the last 5 years?*
Have you received more than 2 tickets or had more than 2 at fault accidents within the last 3 years?*
Education
Name of High School*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
From (year):*
To (year):*
Did you graduate?*
Degree:*
College?*
Name of College:*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
From (year):*
To (year):*
Did you graduate?*
Degree:*
Other?*
Name of School:*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
From (year):*
To (year):*
Did you graduate?*
Degree*
Employment History
Previous Employment History*
Company*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Supervisor*
First Last
Job Title*
Starting Salary $:*
Ending Salary $:*
Responsibilities:*
From:*
To:*
Reason for leaving:*
More employment history?*
Company*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Supoervisor*
First Last
Job Title*
Starting Salary $:*
Ending Salary $:*
Responsibilities:*
From:*
To:*
Reason for leaving:*
More employment history?*
Company*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor*
First Last
Job Title*
Starting Salary $:*
Ending Salary $:*
Responsibilities:*
From:*
To:*
Reason for leaving:*
References
Name*
First Last
Relationship:*
Years known:*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name*
First Last
Relationship:*
Years known:*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name*
First Last
Relationship:*
Years known:*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Military Service
Have you served in the US Military?*
Branch*
From:*
To:
Rank at Discharge:*
Type of Discharge:*
Explain:*

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