Arc of Hunterdon logo The Arc of Hunterdon County
1465 State Route 31, Suite 23
Annandale, New Jersey 08801
908-730-7827
www.archunterdon.org
Employment Application
Personal Information
Date SS#
Last Name First Name
Address
City     State       Zip
Home Phone Alternate Phone
If related to anyone in our employ state name and program:
Referred by:

Employment Desired 
Position you are seeking
Please specify the hours and days you would be willing to work
Date you can start   Salary Desired  
Are you currently employed   Yes      No
If so may we seek a reference from your current employer   Yes       No
*In accordance with the Division of Developmental Disabilities’ Licensing Regulations, all staff must be at least 18 years of age, have a high school diploma or equivalent, and a valid driver’s license.
Are you at least 18 years of age?   Yes      No    Explain 
Do you have a high school diploma or equivalent?   Yes      No    Explain 
Do you have a valid driver’s license?   Yes      No    Explain 
Are your driving privileges revoked in ANY state?   Yes      No    Explain 

Education  
 
Name & Location of High School
Did You Graduate  Yes No Major Subjects of Study
Name & Location of College
Did You Graduate  Yes No Major Subjects of Study
Name & Location of Trade School
Did You Graduate  Yes No Major Subjects of Study
Other areas of special interest:

Previous Work Experience     List below, beginning with present or most current employer
 
Employer Name Employed From/To Dates
Address
Phone Number Fax Number
Salary Reason for Leaving
Employer Name Employed From/To Dates
Address
Phone Number Fax Number
Salary Reason for Leaving
Employer Name Employed From/To Dates
Address
Phone Number Fax Number
Salary Reason for Leaving

References  Give the name of three persons not related to you, whom you have know at least one year

Name                    Business    
Years Known         Address
Phone Number  Fax Number

Name                    Business    
Years Known         Address
Phone Number  Fax Number

Name                    Business   
Years Known         Address
Phone Number  Fax Number
 
In Case of an Emergency Notify

 
Name      Phone Number 
Address 
 
HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR? Yes     No
HAVE YOU EVER BEEN ADJUDGED CIVILLY OR CRIMINALLY LIABLE FOR ABUSE OF A DEVELOPMENTALLY DISABLED PERSON? Yes     No
I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION, UNDERSTAND THAT MISREPRESENTATIONS OR OMISSION OF FACTS CALLED FOR IS CASE FOR DISMISSAL. FURTHER, I UNDERSTAND AND AGREE THAT MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, BE TERMINATED BY EITHER MYSELF OR THE Arc OF HUNTERDON COUNTY AT ANY TIME.
 
**MY SIGNATURE BELOW IMPLIES CONSENT TO OBTAIN INFORMATION RELEVANT TO OBTAINING PROFESSIONAL AND PERSONAL REFERENCES FROM ALL PARTIES LISTED ON THIS APPLICATION. **
Date:                                                      Signature:   
Please print and bring this signed application to your first interview. Electronic signatures are not accepted

 

               

 

 
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