Employment Application

"*" indicates required fields

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify the Human Resources Director.

Position(s) applying for*

First Name*

Middle Name*

Last Name*

Address*

Address 2

City*

State*

Zip*

Phone*

Cell/Other

Email*

Referral Source (How did you hear about us?)*

If you are under 18, can you furnish a work permit?*

Yes

If no, please explain*

Have you ever been employed here before?*

Yes

If yes, give dates and positions*

Are you legally eligible for employment in the United States?*

Yes

(If offered employment, you will be required to provide documentation to verify eligibility.)

Date available for work*

2 digit month

2 digit day

4 digit year

Type of employment desired:*

Full-Time

Part-Time

Temporary

Seasonal

Educational Co-Op

Are you able to perform the essential functions of the job for which you are applying (with or without reasonable accommodation)?*

Yes

Need more information about the job's "essential" functions" to respond

This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.

Driver's license number if driving may be required in position applying for*

Driver's License State of issuance*

Have you ever pled "guilty" or "no contest" to, or been convicted of a crime?*

Yes

Answering "yes" to the above question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.

If yes, please provide date(s) and details*

Employment History

Starting with your most recent employer, provide the following information.

Please select how many previous employment details you would like to enter - up to 3.*

Employer #1*

Address*

Address 2

City*

State*

Zip*

Starting job title/final job title*

Immediate supervisor and title*

Reason for leaving?*

Summarize the type of work performed and job responsibilities.*

Compensation (Starting)*

Hourly

Salary

Compensation (Final)*

Hourly

Salary

Employer #2*

Address*

Address 2

City*

State*

Zip*

Starting job title/final job title*

Immediate supervisor and title*

Reason for leaving?*

Summarize the type of work performed and job responsibilities.*

Compensation (Starting)*

Hourly

Salary

Compensation (Final)*

Hourly

Salary

Employer #3*

Address*

Address 2

City*

State*

Zip*

Starting job title/final job title*

Immediate supervisor and title*

Reason for leaving?*

Summarize the type of work performed and job responsibilities.*

Compensation (Starting)*

Hourly

Salary

Compensation (Final)*

Hourly

Salary

Skills and Qualifications

Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying.*

Computer Skills

Detail software titles you've used and years of experience for each.

Word Processing

Spreadsheet

Presentation

Internet

Other

Please select the number of schools you've attended and will provide information for - up to 3*

School #1*

Years Completed*

Completed at this School*

Please Explain*

Major/Minor

School #2*

Years Completed*

Completed at this School*

Please Explain*

Major/Minor

School #2*

Years Completed*

Completed at this School*

Please Explain*

Major/Minor

Professional License or Membership

(You need not disclose membership in professional organizations that may reveal information regarding race, color, creed, sex, religion, national origin, ancestry, age, disability, marital status, veteran status or any other protected status.)

Please select the number of professional license or memberships you have - up to 3*

Type of License(s) Held*

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with Vision Forward is true, complete and correct.

I expressly authorize, without reservation, Vision Forward, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding Vision Forward, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that Vision Forward does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from Vision Forward and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and Vision Forward reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of Vision Forward is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the forgoing express language are valid unless they are in writing and signed by Vision Forward.

I also understand that, if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an 1-9 Form in this regard.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from Vision Forward’s service, whenever it is discovered.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.

By entering your name below, you certify that you have read, fully understand and accept all terms of the forgoing Applicant Statement.

References

Reference #1 Name*

Title*

Relationship to you*

Phone*

Number of Years Known*

Reference #2 Name*

Title*

Relationship to you*

Phone*

Number of Years Known*

Reference #3 Name*

Title*

Relationship to you*

Phone*

Number of Years Known*