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Job Application - Dutchess County

Application for Employment - Dutchess County Positions
Section I
Referred by
Section II
First Name *
Middle
Last Name *
Country
Address Line 1 *
Address Line 2
City *
State/Province *
Postal Code *
Best Time To Reach You
Are your work records under another name/names? If yes please specify
May we contact your present employer?
Have you previously filed an application with SullivanArc, Arc of Orange County, The Arc Sullivan-Orange Counties or The Arc Dutchess?
Have you previously been employed by The Arc Greater Hudson Valley, SullivanArc, The Arc of Orange County, The Arc Sullivan-Orange, or The Arc of Dutchess?
Are you 18 or over?
Schedule Desired:
(check all that apply):
Are you legally eligible for employment in the U.S.A.?
Have you ever been convicted of a crime? If yes provide date and specify below
Certificate of Rehabilitation?
Do you have any pending criminal charges? If yes provide date and specify below
Do you have a history of substantiated abuse on file in the OPWDD, OMH or DOH system? If yes provide date and specify below
Section III
License
Please be advised that employment offers will be conditional for those positions that require driving. No firm offer will be made until verification of your license and driving history has been completed. Do you currently have a valid NYS or Out of State driver's license?
Section IV - Education
Did you graduate?
Did you graduate?
Section V - Employment Experience
Start Date
–
End Date
ext Extension
Start Date
–
End Date
ext Extension
List any other experiences, skills, qualifications, professional licenses you believe will be beneficial in considering your application.
Section VII - Personal References
No file selected
First Name *
Last Name *
ext Extension
Country
Address Line 1
City
State/Province
Postal Code
First Name *
Last Name *
ext Extension
Country
Address Line 1
City
State/Province
Postal Code
No file selected
No file selected
Applicant Authorizations
The Arc does not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation.
The Arc does not discriminate in employment on the basis of sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factor.
Please Read and Sign
I affirm that the facts set forth in my application are true and complete. I understand that if employed, any omission of facts or false statement on this application may result in my dismissal.
I further understand that this application is not, and is not intended to be, а contract of employment nor does this application obligate the employer in any way if the employer decides to employ me.
I understand and agree that my employment is at-will and can be terminated by either party without notice, at any time, for any reason or no reason.
No one other than an officer of the agency has any authority to enter into any agreement for any employment for any specific period of time or to make any agreement contrary to the foregoing and then only in a written signed statement by an officer.
I authorize The Arc Greater Hudson Valley to make inquiries and investigations of my person, employment history and other related matters as may be necessary in arriving at the employment decision.
I hereby release employers, schools and persons from all liability in responding to inquiries in connection with my application. A criminal conviction will not automatically disqualify my application.
I also understand that I am required to abide by all rules and regulations of the agency and that I will be required to provide proof of citizenship or work permit at time of employmentI also understand that I am required to abide by all rules and regulat
I understand that any offer of employment is conditional pending the results of my Staff Exclusion List Check, Criminal Background Check, Abuse/Neglect History check through OPWDD, Child Abuse Registry Check and Driving Abstract, PPD
First Name *
Middle
Last Name *
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