Application

Employment Application

Contact Information

Name *

First

Last

Position Desired *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Alternate Phone *

Email *

County of Residence *

Social Security Number *

Are you related to anyone in our employ? If so, please state their name/program *

How were you referred to our agency? *

List your work availability (days/hours) *

How soon can you start work? *

Are you currently employed? *

If so, may we contact your employer? *

Previous Work Experience

Most Recent Employer (Name & Title) *

Dates Employed, Reason for Leaving *

Previous Employment (Name & Title) *

Dates Employed, Reason for Leaving *

References

List a professional reference (name and contact info), not related to you, whom you've known at least one year *

List a reference (name and contact info), not related to you, whom you've known at least one year *

List a professional reference (name and contact info), not related to you, whom you've known at least one year *

List a reference (name and contact info), not related to you, whom you've known at least one year *

General Information

Are you able to commit fully to our paid training program which runs Monday through Friday from 9am-5pm during the beginning of your employment with us? *

In accordance with the Division of Developmental Disabilities’ Licensing Regulations, all employees must be at least 18 years of age, have a high school diploma or equivalent, and a valid driver’s license. Do you match this criteria? *

Have you ever applied/worked with us in the past? If so, please explain. *

Have you ever been convicted of a felony or misdemeanor? *

Have you ever been adjudged civilly or criminally liable for abuse of a developmentally disabled person? *

Are you able to lift 100lbs, with assistance of another person? *

DO YOU AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION AND UNDERSTAND THAT MISREPRESENTATIONS OR OMISSION OF FACTS CALLED FOR IS CASE FOR DISMISSAL? *

DO YOU UNDERSTAND AND AGREE THAT YOUR EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY BE TERMINATED BY EITHER YOURSELF OR THE ARC OF HUNTERDON COUNTY AT ANY TIME? *

Submit