Employment Application

Employment Application

BOLD, Inc. does not discriminate on the basis of race, color, age, sex creed or national origin, non-job-relateddisability, sexual orientation or affectional preference, marital status, political or union affiliation. BOLD, Inc. is an equal opportunity employer.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Date Available: *

MonthDayYear
Date
Desired Hourly Rate*
Position Applied for:*
Shift looking to work:*

	YES	NO
Are you a citizen of United States and authorized to work in the USA?
Have you lived in PA for two consecutive years?
Have you ever been convicted of a felony, or any other crime. (put yes if something will come up on your criminal record check)

Education
Education *
High School:*
Address Line 2 City State Zip
College:
Address Line 2 City State Zip
Other:
Address Line 2 City State Zip
References
Name:First Name* Last Name* Company/Relationship:*
Phone:Phone Number*
Name:First Name* Last Name* Company/Relationship:*
Phone:Phone Number*
Name:First Name* Last Name* Company/Relationship:*
Phone:Phone Number*
Previous Employment
Company: * Phone: *
Address:   Street     City   State
Supervisor:First Name   Last Name
Job Title: *  Salary:
From:* To:*
Reason For Leaving:
May we contact your previous Supervisor for a reference?   *
Including work and volunteering, how many years of experience do you have in the field of intellectual and developmental disabilities or as a care taker?
Military Service
Military Service

No Military ServiceActive MilitaryHave Served in the Military
Branch:
From: To:
Rank at Discharge:
Type of Discharge:
If other than honorable, explain:
Branch:
From: To:
Rank:
Please explain your time obligation:
AUTHORIZATION AND RELEASE OF INFORMATION

I hear by give Better Outcomes Living Diversely, Inc. hereafter known as BOLD, and any of its affiliates and divisions, the right to thoroughly investigate my past employment, education, police record, activities, and I release from all liability all persons, companies, and corporations supplying such information. I indemnify BOLD against any liability, which might result from conduction such an investigation. I understand that any false answers, statements, or implication made by e in this application or other required documents shall be considered sufficient cause for denial of employment or discharge.

Additionally, I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between BOLD and myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me and I understand that no such promises or guarantee is binding upon BOLD unless made in writing by the President and Chief Executive Officer. If any employment relationship is established, I understand that I have the right to terminate my employment at any time for any reason or no reason at all, with or without prior notice, and that BOLD retains the same right. I acknowledge by signing below that I fully understand that I am applying to the agency and not one particular home and that the agency may move me from home to home based upon the needs of the individuals.
Signature*

Clear
Date*

MonthDayYear
Date
Type a question
Evaluation comments
Should be Empty:

Employment Application

Education

References

Previous Employment

Military Service