The Arc Sunrise of Central Florida

Contact Information

Name*:

Street Address*:

City*:

State*:

Zip Code*:

Home Phone*:

Work Phone:

How were you referred to us?

Have you used any names other than those listed on this application?*

Yes

Have you ever been found guilty of, regardless of adjudication, or entered a plea of nolo countendere or guilty to, a felony or misdemeanor, other than a minor traffic violation? If so, please describe the nature of and details about the crime, the date of the adjudication or plea, and the penalty imposed as a result of the adjudication or plea. Have you ever been a defendant in a lawsuit for an intentional tort, including but not limited to actions for intentional infliction of emotional distress, assault, battery, false imprisonment, defamation, invasion of privacy, or fraud? If so, please describe the nature of and details about the lawsuit and its final disposition. (In accordance with company policy, this information will be reviewed for job relatedness.)*

Yes

Job Related Skills

Please list any languages in which you are fluent.

Do you have a valid Driver's License?*

Yes

DL#:

Type:

State of Issue:

Have you ever had any moving violations?*

Yes

If yes, please describe:

Do you have an insurable driving record?*

Yes

Please list any other skills, licenses or certificates that may be job related or that you feel would be of value to this job.

Position - Direct Support Professional I

Have you been given a job description or had the requirements of the job explained to you?*

Yes

Do you understand these requirements?*

Yes

Can you perform the essential physical and intellectual requirements of the job explained to you?*

Yes

Work History

Required 2 year work history with 1 year of caregiving experience. Please start with most recent employer.

Company*:

Phone Number*:

Address*:

Supervisor's Name*:

Job Title*:

Starting Salary*:

Ending Salary*:

Responsibilities*:

Start Date*:

End Date*:

Reason for Leaving*:

May we contact your previous supervisor for a reference?*

Yes

Company:

Phone Number:

Address:

Supervisor's Name:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

Start Date:

End Date:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes

Company:

Phone Number:

Address:

Supervisor's Name:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

Start Date:

End Date:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes

References

Please list three (3) professional references that are not relatives.

Full Name*:

Relationship*:

Company*:

Phone Number*:

Address*:

Full Name*:

Relationship*:

Company*:

Phone Number*:

Address*:

Full Name*:

Relationship*:

Company*:

Phone Number*:

Address*:

Getting To Know You

Please help us get to know you. Please answer the following questions to the best of your ability.

What has been your favorite job, and why did you like it?*

If all jobs were paid the same, what profession would you choose and why?*

Why do you like to help people?*

What will you be doing five (5) years from today?*

Please describe any additional information about your work experience in health care, group homes, training centers, home care, or working with individuals with developmental disabilities.

APPLICANT NOTE: This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract and the receipt of this application does not mean that job openings exist and does not obligate the Organization in anyway. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without regard to sex, marital status, race, age, creed, religion, national origin or the presence of disabilities. Qualified applicants may request affirmative action hiring. Additional testing of job related skills and for the presence of drugs in your body may be required prior to employment. After an offer of employment we will conduct background checks including local law and fingerprinting and drug screen. If you need help completing the application, please notify the person that gave you this application. Every effort will be made to accommodate you. The Organization relies upon the accuracy of information contained in the employment application, as well as the accuracy of other data presented throughout the hiring process and employment. Any misrepresentation, falsifications, or material omissions in any of the information or data may result in the Organizations exclusion of the individual from further consideration for employment, or if the person has been hired, termination of employment. We appreciate your interest in our Organization.

Certification & Release: I certify that I have read and understand the applicant note above and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application may result in rejection of my application or discharge at any time during my employment I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.

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Employment Application

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Job Related Skills

Position - Direct Support Professional I

Work History

References

Getting To Know You

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