Office Application for Employment

Transcription

1 Office Application for Employment Dear Applicant: Please complete and return the employment application along with the Family Care Safety Registry [ FCSR ] Workers Registration form to On My Own, Inc. If you are unsure if you are registered with FCSR, you can go online and search by your Social Security Number at If you find you are not registered with FCSR you can then do so by completing the online registration form. The cost when you mail it in is $ It will cost $1.25 more to register online, however the turnaround is usually hours when registering online and mailing can take several months for a result. Please note: We only interview individuals registered with FCSR and who have a satisfactory rating. Both the application and the FCSR form need to be returned regardless if you are already registered with the FCSR or if you register online. We still need to have the information on the FCSR form for internal processing. Also, please make sure you bring your Drivers License and Social Security card so we can get a copy to go with your application and FCSR form. Thank you. Main Office 428 E. Highland Ave Nevada, MO Collins Office PO Box DeLaPorte Collins, MO HR Department Patti Hendrix x30 patti.hendrix@omoinc.org Revised 7/27/2017

2 Revised 7/27/2017

3 Office Application for Employment We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to employment, services, and programs is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the organization. Position Applying For: Date of Application: Social Security Number: Name: Last First M.I. Maiden Name (if applicable): Address: Street City State Zip Code Home Phone: Cell Phone: E mail Address (if applicable): How did you learn about us? Advertisement Employment Agency Friend Relative Walk In Other Have you been employed with us before? Yes No If yes, give date(s) Are you currently employed? Yes No If yes, may we contact your present employer? Yes No On what date would you be available to begin work? What is your availability? FULL TIME PART TIME Would you object to working overtime if necessary? Yes No This job requires consistent regular and punctual attendance; can you meet this requirement? Yes No If you are under the age of 18, can you provide a work permit if it is required? Yes No Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status? Yes No (Proof of citizenship or immigration status will be required upon employment) Have you ever been found or pleaded guilty nolo contendere of a criminal act (minor traffic violations are exempt)? Yes No If yes, please explain in detail (a Yes response will not necessarily prevent employment.) DRIVER S INFORMATION Can you travel if a job requires it? Yes No Are you currently in possession of Automobile Insurance that meets the statutory insurance requirement for the State of Missouri? Yes No Is this insurance presently in effect? Yes No Drivers License Number Issuing State Expiration Date Class Do you have any experience working with people with disabilities? Revised 5/18/2015

4 EMPLOYMENT EXPERIENCE Start with your present or most recent employment. You MUST list at least 5 years of employment history. Please explain, in detail, any gaps in your employment history: Revised 5/18/2015

5 EDUCATION Elementary School High School Undergraduate College/University/Technical Graduate School School Name and Location Years Completed Diploma/Degree Describe course of study Summarize any job related training, skills, licenses, certificates, and/or other qualification: REFERENCES Please provide information on three references that are NOT RELATED TO YOU and are NOT PREVIOUS EMPLOYERS. 1. NAME ADDRESS TELEPHONE NUMBER YEARS KNOWN RELATIONSHIP TO REFERENCE I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information. I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered. If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law. I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified applicant. Applicant Signature Date Revised 5/18/2015

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