APPLICATION FOR EMPLOYMENT

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Individual

Business/Organization

Business/Organization*

First Name*

Last Name*

Email*

Phone number

Ext.

Work Mobile Home

Address Line 1

Address Line 2

City

State/Province

Postal Code

Country

Additional Information For Your Application(s)

1 X APPLICATION FOR EMPLOYMENT

Location

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Position Applying For

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Date Available for Work

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Are you at least 18 years old?

Required

Telephone (Home)

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Telephone (Work)

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Have you ever used any other name(s) which is (are) necessary for us to know in order for us to verify your employment or educational record?

Required

Are you available to work overtime as needed?

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If yes, are you available weekdays?

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Weekends?

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Have you previously worked for, volunteered or applied for a position with Winters Center for Autism?

Required

If yes, please explain when and, if employed, in what capacity

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Do you have any relatives now employed at Winters Center for Autism?

Required

If yes, state name(s) and where they are located.

Optional

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PERMISSION TO WORK

If hired, can you present evidence of your legal right to work in the US?

Required

REFERRAL INFORMATION

How did you learn about Winters Center for Autism?

Required

Employment Agency

Reputation of Organization

Referral

School

Online ad

If Employment Agency, state name

Required

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If Referral, state name

Required

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If School, state name

Required

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If Online ad, website

Required

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Other

Optional

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WORK EXPERIENCE

Please specify your complete full-time and part-time employment history, including self-employment. You may include any verified work performed on a volunteer basis. Begin with your current or most recent employer. If you require additional space, please use the reverse side of this page and/or the following page.

Company Name

Required

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Telephone

Required

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Address

Required

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Name, Title, and Phone Number of Supervisor

Required

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Job Title, and Work Responsibilities

Required

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Employed (Month and Year) From To

Required

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Monthly Wages Start Last

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Reason for Leaving

Required

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Company Name

Required

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Telephone

Required

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Address

Required

Characters Remaining: 500

Name, Title, and Phone Number of Supervisor

Required

Characters Remaining: 500

Job Title, and Work Responsibilities

Required

Characters Remaining: 500

Employed (Month and Year) From To

Required

Characters Remaining: 500

Monthly Wages Start Last

Required

Characters Remaining: 500

Reason for Leaving

Required

Characters Remaining: 500

Company Name

Required

Characters Remaining: 500

Telephone

Required

Characters Remaining: 500

Address

Required

Characters Remaining: 500

Name, Title, and Phone Number of Supervisor

Required

Characters Remaining: 500

Job Title, and Work Responsibilities

Required

Characters Remaining: 500

Employed (Month and Year) From To

Required

Characters Remaining: 500

Monthly Wages Start Last

Required

Characters Remaining: 500

Reason for Leaving

Required

Characters Remaining: 500

Company Name

Required

Characters Remaining: 500

Telephone

Required

Characters Remaining: 500

Address

Required

Characters Remaining: 500

Name, Title, and Phone Number of Supervisor

Required

Characters Remaining: 500

Job Title and Work Responsibilities

Required

Characters Remaining: 500

Employed (Month and Year) From To

Required

Characters Remaining: 500

Monthly Wages Start Last

Required

Characters Remaining: 500

Reason for Leaving:

Required

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Please explain any gaps in your employment

Required

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All employers including your current employer may be contacted to verify the information you provide. May we contact your current employer prior to making an offer of employment?

Required

PROFESSIONAL REFERENCES

Individuals not related to you. Business references preferred.

Name

Required

Characters Remaining: 500

Occupation

Required

Characters Remaining: 500

FI phone #

Required

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Address

Required

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Years Known and Capacity

Required

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Name

Required

Characters Remaining: 500

Occupation

Required

Characters Remaining: 500

Phone

Required

Characters Remaining: 500

Address

Required

Characters Remaining: 500

Years Known and Capacity

Required

Characters Remaining: 500

Name

Required

Characters Remaining: 500

Occupation

Required

Characters Remaining: 500

Phone

Required

Characters Remaining: 500

Address

Required

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Years Known and Capacity

Required

Characters Remaining: 500

EDUCATION & TRAINING

Graduate

Name and Location of School

Required

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Number of Years Completed

Required

Characters Remaining: 500

Degree

Required

Characters Remaining: 500

Type of Course/Major

Required

Characters Remaining: 500

College

Name and Location of School

Required

Characters Remaining: 500

Number of Years Completed

Required

Characters Remaining: 500

Degree

Required

Characters Remaining: 500

Type of Course/Major

Required

Characters Remaining: 500

High School

Name and Location of School

Required

Characters Remaining: 500

Number of Years Completed

Required

Characters Remaining: 500

Degree

Required

Characters Remaining: 500

Type of Course/Major

Required

Characters Remaining: 500

Business/Trade/Technical

Name and Location of School

Required

Characters Remaining: 500

Number of Years Completed

Required

Characters Remaining: 500

Degree

Required

Characters Remaining: 500

Type of Course/Major

Required

Characters Remaining: 500

SKILLS

General Office Skills

Required

Typing

Shorthand

Telephone Console

Data Entry

Print/Copy/Fax/Scan Machines

Mail Equipment

Dictation Transcription

Filing Systems

If typing, wpm

Optional

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If shorthand, wpm

Optional

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List any other office/business skills you possess which are relevant to the position you seek

Optional

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Software and Technology

Check only those with which you are proficient. For those marked with an (*), provide information as to the specific version, release, or model.

Required

MS Word™*

WordPerfect™*

PowerPoint™

Excel™*

Windows™*

Electronic Mail Programs*

Adobe*

Programming/Database Applications*

Document Management Programs*

Social Media Platform Management

Website Platform Management

List any other software programs with which you are proficient, and any other technical skills you possess

Optional

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Do you have any other experience, skills, or qualifications which you feel would benefit Winters Center for Autism? If so, please explain

Required

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ADDITIONAL EMPLOYMENT INQUIRIES

Emergency Contact Person

Name

Required

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Phone Number

Required

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THIS APPLICATION IS NOT COMPLETE UNTIL IT IS FULLY COMPLETED, SIGNED, AND ALL STATEMENTS BELOW HAVE BEEN READ AND INITIALED.

I certify that all of the information furnished on this application and during the application process is true, complete and correct to the best of my knowledge. I understand that any misrepresentation or omission of facts called for may result in refusal to hire or, if hired, may result in my dismissal at any time regardless of when the false answer or omissions are discovered.

Initial

Required

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I recognize that this employment application is not an offer of employment. I agree that if I am hired by Winters Center for Autism, I will be an at-will employee, meaning that either Winters Center for Autism or I may end the employment relationship at any time with or without cause or notice.

Initial

Required

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I agree to submit to legally permissible drug testing upon an offer of employment from Winters Center for Autism and prior to starting work. I agree that any offer of employment is contingent upon my receiving a negative test result.

Initial

Required

Characters Remaining: 500

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