TKW Introduction Application

Thank you for your interest in joining TKW!

We are a NC Innovations Waiver Provider that specializes in serving the I/DD population.

There are generally two positions available within our company, Direct Care Provider and A.F.L Provider. The job descriptions are included in this application for your review.

Please note that we do not immediately place new staff as A.F.L Providers. We first like to build a relationship and see how you work with the population. It will be a considerable amount of time before we recommend you as an A.F.L. Provider, regardless of experience.

Work hours are based upon the individual you may be assigned to, therefore they may very. Most work will start as fill in or part time until you can be assigned a full time client.

Please be sure to include any relevant experience for the position you are applying for.

There is a $35.00 fee required to process your background check. Your background check will not be submitted until the fee has been paid.

You can pay online through the Squarepay portal at the end of this application, or bring cash or a money order to the office.

No Checks

If you choose to pay in person, please call ahead so we know to expect you.

If you are approved to continue with the hiring process, your fee will be refunded on your first paycheck. If you are not approved, you will receive a copy of your background check for your records.

Once your payment is received, your background check will be submitted. Processing takes approximately 3–5 business days.

-Sydney Moncur. Onboarding Specialist

E-mail: theworkshop@tkwinc.org

Phone : 704-399-4045 EXT:12

Fax :704-399-4089

5901 Beatties Ford Road

Charlotte NC, 28216

Date of Application*

Date

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How did you hear about us?*

How long have you lived at your current address?*

Do you have a previous address?*

How long did you live at your previous address?

How long have you lived in North Carolina?*

Date of Birth*

Date

Social Security Number

Driver's License Number*

Email*

example@example.com

Please upload a copy of your driver's license*

Cell Phone Number*

Please enter a valid phone number.

Home Number

Please enter a valid phone number.

List any relatives or friends working with The Workshop

Have you ever been convicted of a criminal offense (felony or misdemeanor)?*

YesNo

If yes, please state the nature of the offense(s), dates(s), city, state and disposition. An affirmative answer will not necessarily result in disqualification for employment.

Please upload a copy of your resume.*

Please review the job descriptions for a Direct Care Provider or AFL Provider.

Position Desired*

Hourly Rate Desired*

What days and hours are you available to work?*

When are you available to start work?*

Are you over the age of 18?*

YesNo

Are you able to perform the essential functions of the job for which you are applying? We comply with the Americans with Disabilities Act and consider reasonable accommodation measures that may be necessary for eligible applicants to perform essential functions.*

YesNo

Do you speak, write or understand any foreign languages? If yes, which language(s) and with what proficiency*

YesNo

If yes, which language(s) and with what proficiency

Are you able to operate a personal computer?*

YesNo

If yes, what types of software?

What knowledge, special skills, training, license(s) and/or certification(s) do you have that especially prepare you for the position you are applying for? (CPR, First Aid, etc.)*

High School Name*

Did you graduate?*

YesNo

College/University Name

Did you graduate?

YesNo

Major Field(s) of Study

Graduate or Professional

Did you graduate?

YesNo

Major Field(s) of Study

Company Name & Address*

City, State, Zip Code*

Dates Employed*

Job Title*

Supervisor Name*

Phone Number*

Please enter a valid phone number.

Specific Job Duties*

Is this your current employer?*

YesNo

May we contact this employer?*

YesNo

Reason for leaving*

If you are still with the company, please put N/A

Company Name & Address

If you are still with the company, please put N/A

City, State, Zip Code

If you are still with the company, please put N/A

Dates Employed

Job Title

Supervisor Name

Phone Number

Please enter a valid phone number.

Specific Job Duties

Is this your current employer?

YesNo

May we contact this employer?

YesNo

Reason for leaving

If you are still with the company, please put N/A

Company Name & Address

City, State & Zip Code

Dates Employed

Job Title

Supervisor Name

Phone Number

Please enter a valid phone number.

Specific Job Duties

Is this your current employer?

YesNo

May we contact this employer?

YesNo

Reason for leaving

If you are still with the company please put, N/A

Full Name*

Phone Number*

Relationship*

# Years Known*

Full Name*

Phone Number*

Relationship*

# Years Known*

1. The information that I have provided on this application is accurate to the best of my knowledge and may be verified by The Kid’s Workshop or its agents. *

2. I authorize all the schools, persons and organizations named in this application to provide any relevant information in their possession or knowledge to the agents of The Kid’s Workshop, for use in deciding whether or not to offer me employment. I hereby waive any required written notification and release The kid’s Workshop, my former employers and all other persons named on this application from any and all claims, demands or liabilities arising out of or in any way related to such inquiry or disclosure*

3. I understand that The Kid’s Workshop is committed to maintaining a drug and alcohol free work place. Accordingly, I understand that if The Kid’s Workshop has a reasonable suspicion that I am under the influence of drugs and/or alcohol, I may be subject to a blood test, urinalysis or other drug/alcohol screening.*

4. I authorize the Kid’s Workshop to obtain a background check for use in determining whether or not I am offered employment. I understand that if employment with The Kid's Workshop is denied or terminated based on information obtained through any background check, I will be provided with the name, address and telephone number of the reporting agency.*

5. I understand and agree that any misrepresentation or omission of facts in this application will be justification for refusal or termination of employment, regardless of the time elapsed before discovery.*

6. I understand and agree that the employment for which I am making application is, and is intern to be, at-will and such employment may be terminated at any time with or without cause, without prior notice, by myself or The Kid’s Workshop. The will be no agreement, expressed or implied between The Kid’s Workshop and myself for any specific period of employment, nor for continuing long term employment unless made in writing, signed by a member of The Kid’s Workshop Executive Management Team.*

7. I have placed my signature in the space provided below only after I have completed the entire application to the best of my ability and have carefully read the preceding seven (7) statements.*

Applicant's Signature*

Date*

Date

PERSONAL INFORMATION

SKILLS

EDUCATION

Employment History

Personal References

APPLICANT'S STATEMENT

CASTLEBRANCH BACKGROUND CHECK AUTHORIZATION

Business Reference

Payment Methods