Join
the Staff of Options for Community Living, Inc. |
| PERSONAL |
| First Name:
Middle Initial:
Last Name:
|
| Street Address:
|
| City:
State:
Zip Code:
|
| Phone: Daytime:
Evening:
|
| Email Address:
|
| Have you previously applied to or
worked for our organization? |
Yes
No |
| How did you learn about this job? |
|
| Are you related to anyone in our
employ? |
Yes
No |
| Are you 18 years of age or over? |
Yes
No |
| Are you legally authorized to work
in the U.S.? |
Yes
No |
| Have you ever been convicted of
a crime? |
Yes
No |
If yes, provide details
(nature of offense, when,
where, and disposition): |
|
| Has the Office of
the Inspector General ever excluded you from participation
in Federal
health care programs?
|
Yes
No |
| POSITION |
| Position interested in: |
|
| Hours Desired: Please check all that apply |
full time
part time
per diem
|
| Shift preference: Please check
all that apply |
|
day
evening
night
weekend
|
| Date available to start:
|
Salary desired:
|
| EDUCATION |
|
| Highest level of education attained: |
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| Major/Specialty: |
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| LICENSES, CERTIFICATIONS
AND REGISTRATIONS |
| Please list any licenses, certifications
or registrations you may have:
|
|
| RESUME AND COVER LETTER |
Please attach
your resume and a cover letter (.DOC OR .PDF
ONLY)
|
| If you do not have a
resume, please complete the Employment History Form
which appears below. If you have already attached a
resume and cover letter, you may submit your information
now
|
| Employment
History Form |
| Starting with the most recent, describe all paid
employment and military experience |
| 1. Job Title: |
|
Date (from-to):
|
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| Employer: |
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| Employer Telephone: |
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| Employer Address: |
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| Supervisor: |
|
Title: |
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| Description of Duties and Accomplishments: |
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| Final Salary : |
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| 2. Job Title: |
|
Date (from-to):
|
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| Employer: |
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| Employer Telephone: |
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| Employer Address: |
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| Supervisor: |
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Title:
|
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| Description of Duties and Accomplishments: |
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| Final Salary : |
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| Reason for Leaving: |
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| 3. Job Title: |
|
Date (from-to):
|
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| Employer: |
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| Employer Telephone: |
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| Employer Address: |
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| Supervisor: |
|
Title: |
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| Description of Duties and Accomplishments: |
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| Final Salary : |
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| Reason for Leaving: |
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| 4. Job Title: |
|
Date (from-to): |
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| Employer: |
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| Employer Telephone: |
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| Employer Address: |
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| Supervisor: |
|
Title:
|
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| Description of Duties and Accomplishments: |
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| Final Salary: |
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| Reason for Leaving: |
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| Please explain any gaps in employment: |
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