Progress Job Application

Employment History - Provide Entire Previous 5 Years

*Applications will not be processed without a full 5 year history. *All gaps greater than 30 days must be detailed on the application. Document previous employment or gaps in employment in chronological order starting with most your most recent job...if there is a gap during employment greater than 30 days, please explain.
Present or Last Employer Name
Address
City, State Zip
Starting Date
Leaving Date
Job title
Starting salary or wage
Final salary or wage
Supervisor's name and title
Employer's phone
Description of Work
Reason for Leaving
Previous Employer Name
Address
City, State Zip
Starting date
Leaving date
Job title
Starting salary or wage
Final salary or wage
Supervisor's name and title
Employer's phone
Description of work
Reason for leaving
Previous Employer Name
Address
City, State Zip
Starting date
Leaving date
Job title
Starting salary or wage
Final salary or wage
Supervisor's name and title
Employer's phone
Description of work
Reason for leaving
Previous Employer Name
Address
City, State Zip
Starting date
Leaving date
Job title
Starting wage or salary
Final wage or salary
Supervisor's name and title
Employer's phone
Description of work
Reason for leaving
Previous Employer Name
Address
City, State Zip
Starting date
Leaving date
Job title
Starting salary or wage
Final salary or wage
Supervisor's name and title
Employer's phone
Description of work
Reason for leaving
Previous Employer Name
Address
City, State Zip
Starting date
Leaving date
Job title
Starting salary or wage
Final salary or wage
Supervisor's name and title
Employer's phone
Description of work
Reason for leaving
Previous Employer Name
Address
City, State Zip
Starting date
Leaving date
Starting salary or wage
Final salary or wage
Supervisor's name and title
Employer's phone
Description of work
Reason for leaving
Previous Employer Name
Address
City, State Zip
Starting date
Leaving date
Job title
Starting salary or wage
Final salary or wage
Supervisor's name and title
Employer's phone
Description of work
Reason for leaving
Any employment gaps greater than 30 days, please explain here:

Personal References

Give the names of THREE persons you are not related to, whom you have known for at least ONE year. ONE of those persons you must have known for at least FIVE years.
Personal Reference 1 - Name
Address
City, State Zip
Phone
Years known
Personal Reference 2 - Name
Address
City, State Zip
Phone
Years known
Personal Reference 3 - Name
Address
City, State Zip
Phone
Years known
Employee Reference Information
Authorization

*I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability from any damage that may result from utilization of such information.
Name of Applicant

First Name Last Name
*Signature

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Criminal backgrounds

Progress Inc. is a licensed provider agency that receives funding from state / federal sources and HMOs (insurance companies). These sources dictate to Progress through our contract language that applicants with certain criminal convictions may not be able to work for our company. In certain situations, Progress may be able to ask our funding sources for an exception from these rules that prohibit us from hiring applicants with certain criminal convictions. These exception requests can take up to 14 days to receive an answer. Progress will do its best to hold a position vacant while awaiting an exception request to be answered.
Have you been convicted of a felony? (Please read the statement above.)

Yes No
If yes, please explain.
Have you been convicted of a misdemeanor? (Please read the statement above.)

Yes No
If yes, please explain.
I, the undersigned applicant, certify and affirm that, to the best of my knowledge and belief; I have or have not (INDICATE BELOW) had a case of abuse, neglect, mistreatment, or exploitation substantiated against me. As a condition of submitting this application and in order to verify this affirmation, I further release and authorize Progress Inc. and the Tennessee Department of Intellectual and Developmental Disabilities Services (DIDDS) to have full and complete access to any and all current or prior personnel or investigative records from any party, person, business or agency, as pertains to any allegation(s) against me of abuse, neglect, mistreatment, or exploitation and to consider this information as may be deemed appropriate.
Answer to above statement:

Have Have not
If have, explain:
***Important, Please Read & Sign

PLEASE BE ADVISED THAT TENNESSEE STATE LAW REQUIRES CRIMINAL BACKGROUND CHECKS OF APPLICANTS FOR ALL PERSONS THAT WORK DIRECTLY WITH INDIVIDUALS SERVED BY PROGRESS.
*I agree to release all investigative records about myself from any source, including Federal, State, and Local Governments. I also understand that Progress Inc. is an at-will employer and if I am offered a position, my employment may be terminated by Progress Inc. with or without notice, for any reason, including the result of information from a criminal background or MVR check and/or Employment History.
*Signature

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Date

Month Day Year
Date

AUTHORIZATION
*I certify that the facts contained in this application are true and complete to the best of my knowledge, and understand that if employed, falsified statements on this application shall be grounds for dismissal.
*Signature

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Date

Month Day Year
Date
Progress Inc. is an "At Will" employer and in no way should this application be interpreted as any contract of employment."At Will" means that employment may be terminated at any time by either party for any reason other than discrimination, withor without notice given.
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Progress Application for Employment

Vehicle Information

Desired Employment

Who referred you to Progress?

General Information

Employment History - Provide Entire Previous 5 Years

Personal References

Employee Reference Information

Criminal backgrounds

***Important, Please Read & Sign

AUTHORIZATION