Job Training Application

Fill out the form below to apply

First Name *

Address *

Email *

Are you fluent in the English Language? *

Last Name *

City *

Phone *

Are you willing to work Overtime/Rotating Shifts/Locations? *

Middle Initial

State *

Social Security # *

Do you have a Drivers License? *

Application Date

Zip *

Date available to work *

Are you eligible to drive? *

Check the groups you have experience working with

Infants
Pre-School
Youth Groups
Adults/Seniors

Have you ever applied for employment with Respond, Inc.? *

Are you eligible for employment in the United States? *

How did you learn of our program?

Most Recent Employer *

Supervisor

Salary per month *

Job Title *

Contact Person

Dates Employed *

Address / City / State / Zip

Phone

Reason for leaving

Previous Employer 1

Supervisor

Salary per month

Job Title

Contact Person

Dates Employed

Address / City / State / Zip

Phone

Reason for leaving

Previous Employer 2

Supervisor

Salary per month

Job Title

Contact Person

Dates Employed

Address / City / State / Zip

Phone

Reason for leaving

Personal Reference 1 Name *

Address / City / State / Zip

Phone *

Relationship *

Personal Reference 2 Name *

Address / City / State / Zip

Phone *

Relationship *

Personal Reference 3 Name *

Address / City / State / Zip

Phone *

Relationship *

Application Date

Applicant Initials *

By entering your initials, you declare that the information contained in this application is true and correct to the best of your knowledge. You also understand that any false information found in this application will tend to make this application 'Null and Void.'

Name

Applicant’s Statement

I hereby declare that the information provided by me in this application for employment is true, correct and complete to the best of my knowledge. I understand that any misstatement or omission of fact on this application shall be considered cause for refusal to hire, or if employed, dismissal.

I authorize investigation of all statement contained in this application for employment as may be necessary in arriving at an employment decision. I authorize the release of any criminal history record information by any police agency. And such information released as a result of the authorization shall be used only for the express purpose of processing the above application. I understand I have the right o make a written request within a reasonable period to receive additional detailed information about the nature and scope of any investigation.

I understand and agree that if employed, the employment will be “at will”. That is either I or Respond, Inc. may end the employment relationship at any time, for any reason, or for no reason. I also acknowledge that Respond Inc. reserves the right to amend or modify the policies in its handbook or other policies at any time, without prior notice, and agree that I am bound by these including Respond, Inc’s anti-harassment policy.

I understand and agree that, as a condition of employment with Respond, Inc., should be offered, I must submit to and pass successfully all pre-employment examinations required by Respond, Inc., including drug/alcohol screening and background checks.

Job Training Application

Applicant’s Statement

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