The Arc of Salem County

The Arc of Salem County

150 Salem-Woodstown Road, Salem NJ 08079
The Arc is an Equal Opportunity Employer. We consider applicants for all positions without regard to race, color, religion, sex, sexual orientation, national origin, age, marital or veteran status, the presence of a non-job related medical condition or disability, or any other legally protected status.
Position applied for*
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Full TimePart Time
Referral Source*

thearcsalem.orgWalk inInternet job siteEmployment agencyReferred by friendReferred by familyFacebook AdRadio Ad
List any relatives currently employed by The Arc and your relationship.*
Have you filed an application before?*

YesNo
If yes, give date*
Are you employed now?

YesNo
If yes, may we contact your employer?*

YesNo
Name*

First NameMiddle NameLast NameSuffix
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Best number to reach you?*

Area CodePhone Number
E-mail*
Are you at least 18 years of age?*

YesNo
Do you possess a valid NJ driver's license, not probational or provisional?*

YesNo
Exp. Date*
Do you have 5 or less points on your driving record?*

YesNo
EDUCATIONAL BACKGROUND:
A. List last three (3) schools attended, including high school: B. List number of years completed; C. Indicate degree, diploma earned, if any; Proof of degree/diploma/GED required.

	A. Name of School	B. Years Completed	C. Degree Sought	D. Graduated Y/N
High School
College
College

REFERENCES: List name and telephone number of three business/ work references that are not related to you and are not previous supervisors. If not applicable, list three school or personal references that are not related to you.

	Name	Telephone	Years Known
Reference One
Reference Two
Reference Three

Employment History
List your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military experience. Explain any gaps in employment in comments section below.
Employer 1*

NameTelephone
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Title*
Immediate Supervisor and Title*
May we contact for references?*

YesNo
Start Date End Date

Job Summary
Summarize the nature of your work performed and responsibilities*
Reason for leaving*
Employer 2*

NameTelephone
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Title*
Immediate Supervisor and Title*
May we contact for references?*

YesNo
Start Date End Date

Job Summary
Summarize the nature of your work performed and responsibilities*
Reason for leaving*
If you do not have any further positions to list, please enter N/A in each field.
Employer 3

NameTelephone
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Title
Immediate Supervisor and Title
May we contact for references?

YesNo
Start Date End Date

Job Summary
Summarize the nature of your work performed and responsibilities
Reason for leaving
Employer 4

NameTelephone
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Title
Immediate Supervisor and Title
May we contact for references?

YesNo
Start Date End Date

Job Summary
Summarize the nature of your work performed and responsibilities
Reason for leaving
Comments including explanation of gaps in employment*
Last 4 digits of your Social Security*
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status is required upon employment)*

YesNo
As this agency serves people with developmental and intellectual disabilities, The State of NJ Department of Health requires employees to submit to fingerprinting.
Have you ever been civilly or criminally liable of a crime against a person with a developmental or intellectual disability in the state of NJ?*

YesNo
Have you ever pled "guilty" or "no contest" to, or been convicted of a crime?*

YesNo
Answering "yes" to this question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness, and nature of the violation, rehabilitation, and position applied for will be taken into account.
I AGREE*

Some positions require completion of a confidential survey prior to consideration for a position. This survey is used as a tool and results will be used when determining if an applicant will continue to the interview process.
AGREEMENTS*

This serves as notice that The Arc of Salem County requires results of a satisfactory drug and alcohol screening test prior to beginning employment. Thereafter, tests will be performed on a random basis and will be conducted at a local medical site. Under the State of NJ Department of Health regulations, positive results for any controlled substance, illegal drug, or marijuana, even if medically prescribed, may preclude you from employment consideration and/or may result in immediate termination of employment. Signing below indicates the acknowledgement of this policy.
I AGREE*

I give the Agency the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the Agency and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information. It is understood and agreed that any misrepresentation by any in the application will be sufficient cause for cancellation of this application and/or termination from the company’s service if I have been employed.
I AGREE*

The Agency is an equal opportunity employer. The Agency does not discriminate in employment and no question on this application is used for the purpose of limiting or excluding any applicant’s consideration for employment on a basis prohibited by local,state, or federal law.
I AGREE*

This application is current for only (90) days. At the conclusion of this time, if I have not heard from the Agency, and still wish to be considered for employment, it is necessary for me to fill out a new application.
I AGREE*

By signing below, I understand and agree that The Arc of Salem County makes no representation that employment with the Agency is a guarantee of continued employment. I further understand that my employment will be on an at-will basis, and that neither I, nor the company, or its representatives have entered into a contract regarding the duration of my employment. Both The Arc and I are free to terminate my employment with The Arc of Salem County at any time, with or without cause or advanced notice. I further understand that no representative of the Agency has the authority to make or imply any assurances to the contrary.
Full Name*

First NameMiddle NameLast Name
Signature*

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