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Complete this application for consideration of jobs at Choices In Community Living.

Job Application
   *Your Email Address:
   
   * Have you worked for Choices In Community Living Before?
   
    If "YES", what dates did you work for us?
   
   * First name
   
   * Last name
   
   * Complete address
   
   * Home phone
   
   * Social Security Number
   
   

What type of position are you interested in?


   
   * Are you able to work weekends?
   
   * Are you able and willing to work 24-hour shifts?
   
   * If hired, on what date will you be available to start work?
   
   * Have you known, or do you know, someone who works at Choices In Community Living?
   
    If "YES", who?
   
   * What education, qualifications, experience and or skills do you possess which make you feel qualified to assist people with developmental diabilities, or perform the job for which you are applying?
   
   *

Have you ever been convicted of a crime, including sex-related or child abuse related offenses?

 

A conviction record will not necessarily be a bar to employment. This information will be used for job related purposes, and only to the extent permitted by applicable law.


   
    If  "Yes" please explain
   
   *

Did you graduate?


   
    Major or Minor in?
   
   

List all additional education


   
   *

Please list personal references who can speak of your general character. Do not include former employers or relatives. Please include Name/Address/Occupation/Telephone No. for each person listed.


   
   *

Have you ever served in the armed forces?

 


   
    Dates of duty: From  To
   
    Rank at discharge
   
    Explain your duties in the service including any special training you received?
   
   *

List in chronological order, beginning with current or last employer

 

Employer/Occupation


   
   *

Address:


   
   * Telephone No.
   
   * Supervisor
   
   * Dates employed: From   To
   
   * Rate of pay: Start   End
   
   * Reason for leaving
   
   * Description of work pefromed
   
    Employer/Occupation
   
   

Address


   
    Telephone No..
   
    Supervisor
   
    Dates employed: From   To
   
    Rate of pay: Start  End
   
    Reason for leaving
   
    Description of work peformed:
   
    Employer/Occupation
   
    Address
   
    Telephone No..
   
    Supervisor
   
    Dates employed: From  To
   
    Rate of pay: Start  End
   
    Reason for leaving
   
    Description of work peformed:
   
   * May we contact the employers listed?
   
   

If "NO"indicate which one(s) you do not wish us to contact?


   
   * Explain your philosophy for working with developmentally disabled persons?
   
   *

Please summarize below any additional information which you feel may be helpful in our selection process?