ADDS Employment Application

ADDS Employment Application
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Name*

First NameMiddle NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Permanent Address

Street Address

Street Address Line 2

CityState

Zip Code
Best Phone Number*
Please enter a valid phone number.
Alternate Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Referred By

First NameLast Name
Position Desired
Potential Start Date (or estimated)

MonthDayYear
Date
Salary or Wage Desired (or a range)*
Are you currently employed?*

YesNoOther
If yes, may we contact your present employer?*

YesNoOther
Have you ever applied to ADDS before?*

YesNoDon't RecallOther
If you have applied before, for what position and when?

Previous Employment
Name, City and State or Present/Former Employer
Dates of Employment
Salary or Wage
Position or Job Title
Reason for Leaving
Name, City and State or Present/Former Employer
Dates of Employment
Salary or Wage
Position or Job Title
Reason for Leaving
Name, City and State or Present/Former Employer
Dates of Employment
Salary or Wage
Position or Job Title
Reason for Leaving
Name, City and State or Present/Former Employer
Dates of Employment
Salary or Wage
Position or Job Title
Reason for Leaving

References
Reference #1

First NameLast Name
Phone Number
Please enter a valid phone number.
City and State
Length of Association (Years, Months, etc.)
4 years and 3 months
Nature of Relationship
Former employer, past instructor, Pastor, etc.
Reference #2

First NameLast Name
Phone Number
Please enter a valid phone number.
City and State
Length of Association (Years, Months, etc.)
4 years and 3 months
Nature of Relationship
Former employer, past instructor, Pastor, etc.
Reference #3

First NameLast Name
Phone Number
Please enter a valid phone number.
City and State
Length of Association (Years, Months, etc.)
4 years and 3 months
Nature of Relationship
Former employer, past instructor, Pastor, etc.
Reference #4

First NameLast Name
Phone Number
Please enter a valid phone number.
City and State
Length of Association (Years, Months, etc.)
4 years and 3 months
Nature of Relationship
Former employer, past instructor, Pastor, etc.

Verification Statement and Signature
“I certify that the facts contained in this application are true and complete, and I understand that if employed, falsified statements on this application are grounds for dismissal.

I authorize the investigation of all statements contained herein 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 ADDS from liability for any damage that may result from the utilization of such information.

I also agree and understand that no representative of ADDS has any authorization to enter any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing unless it is in writing and signed by an authorized ADDS representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

I understand that a criminal records check may be necessary prior to my employment. If such a report is required, I understand that, in compliance with federal law, ADDS will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to this report.

I also understand that a conviction will not automatically result in disqualification from employment."

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States.
Signature of Affirmation*

Clear
Please verify that you are human*
Should be Empty:

ADDS Employment Application

Return to the ADDS Website