Employment Appplication

Full Name

First NameLast Name

Date

MonthDayYear

Desired Position

What strengths do you think you will bring to this job?

How do you feel you can affect the lives of people with Developmental Disabilities?

How do you feel your attendance and punctuality could affect the people living in the facility or home you are working in?

How did you hear about the job?

In your opinion, what is the most important quality you feel we should look for in our applicants? And why?

Please answer all questions. Resumes are not a substitute for a completed application.

I understand that neither this application nor any communication by a management representative is intended to create or does create a contract of employment, offer, or promise of employment. I acknowledge that if hired by the company, employment is on an at-will basis. This means the company is free to terminate my employment at any time. With or without cause or advance notice, in accordance with state law, and acceptance of employment is not a contract of employment for any specified time. Similarly, I am free to terminate my employment with the company at any time for any reason. This at-will provision may be modified or waived only in a written agreement signed by an authorized representative of the company and me. I agree to conform to the rules and regulations of the company, and I understand that the company has complete discretion to modify such rules and regulations at any time, except that it wil not modify its policy of employment at-will.

We are en equal opportunity employer. Applicants are considered for positions without regard to race, religion, sex, national origin, age, disability, or any other consideration made unlawful by applicable federal, state or local laws.

Please check box to acknowledge and agree.

Full Name

First NameLast Name

Phone Number

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Desired Salary (per hour)

If under the age of 18, can you produce the necessary work certificate at the time of employment?

Type of employment desired

I you answered 'Part Time', what are the desired days/hours?

Are you wiling to work overtime?

Date on which you can start:

MonthDayYear

Have you ever applied to Suncoast New Options before?

If Yes, when did you apply?

Within the past ten (10) years, have you been convicted of a felony? (Do not include convictions that were sealed, eradicated, erased, or expunged; conviction that resulted in referral to a diversion program; or marijuana-related convictions that are more than two (2) years old.)

If yes, please explain so that individual circumstances can be considered.

Criminal convictions will not automatically disqualify an applicant from a particular job. The company will consider nature of the crime, its seriousness, whether the conviction(s) substantially relates to the position’s functions and qualifications, the frequency of convictions, the applicant’s age at the time of conviction, the time elapsed since the date of conviction or completion of jail sentence, the applicant’s entire work and educational history, and employment references and recommendations.

An ex-offender who is denied employment may, upon written request, receive a statement of the reason(s) for denial within 30 day of the applicant’s request for such information.

Have you ever initiated an act of violence in the workplace?

If yes, please explain so that individual circumstances can be considered. (A “Yes” answer will not necessarily disqualify you from employment.)

List special technical skills that you feel qualify you for the job for which you are applying (i.e., your programming/language, software, equipment operation, special tools or machines, etc.):

High School Information

High School Name

High School Location

Did you graduate?

Do you have a GED?

Number of Years Completed

College/Secondary School Information

College Name

College Location

Did you earn a degree?

Course of study

If Yes, what was your major?

Honors received

Number of Years Completed

Business, Techinical, Trade School or Post College Information

School Name

School Location

Course of study

What type of program or certification did you complete?

Did you complete the course?

Honors received

Start with your present or last place of employment. You may include any verifiable work performed on a volunteer basis, internships, or military service.

Last or Current Employer

Job Title

Company Name

Type of Business

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Date Employed To

MonthDayYear

Date Employed From

MonthDayYear

Supervisors Name

First NameLast Name

May we contact?

Starting Wage

Final Wage

Duties

Reason for leaving

Previous Employer #1

Job Title

Type of Business

Company Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Date Employed To

MonthDayYear

Date Employed From

MonthDayYear

Supervisors Name

First NameLast Name

May we contact?

Starting Wage

Final Wage

Reason for leaving

Duties

Previous Employer #2

Job Title

Type of Business

Company Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Date Employed From

MonthDayYear

Date Employed To

MonthDayYear

Supervisors Name

First NameLast Name

May we contact?

Starting Wage

Final Wage

Duties

Reason for leaving

Please list the names of additional work-related references we maycall. Individuals with no prior work experience may list school or volunteer related references.

Reference #1

Full Name

First NameLast Name

Position

Company

Work Relationship

Phone Number

Area CodePhone Number

Reference #2

Full Name

First NameLast Name

Position

Company

Work Relationship

Phone Number

Area CodePhone Number

Reference #3

Full Name

First NameLast Name

Position

Company

Work Relationship

Phone Number

Area CodePhone Number

Preferred work location

Personal Information

Education

Work Experience

References