Employment Application Positive Pathways, An Equal Opportunity Employer. If applicable to Company, reasonable accommodation under the Americans with Disabilities Act will be provided as required by law.Name* First Last Address Street Address City State / Province / Region ZIP / Postal Code Date of Birth:* Month Day Year Email* PhoneAre you either a US citizen or an Alien authorized to work in the US?* Yes No Have you lived in your current county of residence for the past 3 years? Yes No Position Desired:* Wage/Salary Desired: Employment Desired:* Full Time Part Time Have you ever been convicted of a felony, or a misdemeanor involving any violent act, use or possession of a weapon, or act of dishonesty for which the record has not been sealed or expunged, or do you have such a case pending?* Yes No If yes, please explain?* Date Available to Start?* Month Day Year Are you over 18 years of age?* Yes No Any offer of employment is conditioned upon completing form I-9 and providing the appropriate documents for identity and work authorization.EducationHigh SchoolSchool NameAddress# of Years CompletedDid you graduate?Field of Study/MajorCollege - UndergraduateSchool NameAddress# of Years CompletedDid you graduate?Field of Study/MajorCollege - MastersSchool NameAddress# of Years CompletedDid you graduate?Field of Study/MajorOther (specify):Your Availability for Work Select All Monday Tuesday Wednesday Thursday Friday Saturday Sunday Hours Available?Total hours per week you are available to work:* Do you have any special requests or needs for a work schedule? General InformationAre you currently certified in First Aid and CPR? Yes No If yes, date of expiration: Are you currently certified in a non-violent behavior management training (i.e. CPI, MANDT, etc.)? Yes No Are you currently certified in CORE A and CORE B? Yes No If yes, do you have a copy of it? Employment History (Most recent employment first)Current/Most Recent EmployerEmployer NameAddressPosition HeldSalaryDate of Employment:FromToReason for leaving: Supervisor: Your duties: PhoneMay we contact this employer? Yes No Employer #2Employer NameAddressPosition HeldSalaryDate of Employment:FromToReason for leaving: Supervisor: Your duties: PhoneMay we contact this employer? Yes No Employer #3Employer NameAddressPosition HeldSalaryDate of Employment:FromToReason for leaving: Supervisor: Your duties: PhoneMay we contact this employer? Yes No Give Three References That Are Not Former Employers Who We May Contact*NameHow do you know them, and for how long?Telephone NumberEmail *NameHow do you know them, and for how long?Telephone NumberEmail *NameHow do you know them, and for how long?Telephone NumberEmail CAREFULLY READ EACH STATEMENT BEFORE SIGNING AT THE BOTTOM* I certify and authorizeI certify that all of the information provided in this employment application is true and complete to the best of my knowledge, and I authorize investigation of all statements contained in this application, including a criminal background (state and county) checks and Bureau of Motor Vehicle check. I understand that any false or incomplete information may disqualify me from further consideration for employment and may result in my immediate discharge if discovered at a later date. I understand and acknowledge that unless otherwise defined by applicable law or written agreement with Positive Pathways, any employment relationship with the Positive Pathways is considered “employment at will.” This means the Employee may resign at any time and the Employer may discharge the Employee at any time, with or without cause, and with or without advance notice. I authorize the investigation of any or all statements contained in this application and also authorize any person, school, current employer, past employers, and other organizations to provide information concerning my previous employment and other relevant information that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I have read, understand, and agree to the above statements.
