Growth Ability Services

New Hire Application

Growth Ability Services
Submitted Date

YearMonthDay
GROWTH ABILITY SERVICES VISION

To provide companionship and proper care to all of our members with developmental disabilities, facilitating their lives, as well as the lives of their families.
Is our vision compatible with yours?
I have consistent and reliable means of transportation (e.g., personal vehicle, rideshare, or public transit) that allows me to travel to assigned locations as required.
I have access to a working mobile device with active service, which I can use for job-related communication and required check-in processes.
I understand the importance of timely communication and confirm that I am able to respond to messages, calls, and work-related updates within a reasonable timeframe.
If no to any, please explain:

0/300
CRIMINAL HISTORY DISCLOSURE

This position requires compliance with state and federal regulations, including obtaining and maintaining an Arizona Fingerprint Clearance Card, submitting to a Centralized Background Check that includes checks against the Adult Protective Services (APS) and Department of Child Safety (DCS) registries, screening against the List of Excluded Individuals and Entities (LEIE), and providing a criminal history self-disclosure form.
Have you ever been convicted of a felony or misdemeanor?
If yes, please provide details of the conviction(s), including the nature of the offense(s), the date(s), and the jurisdiction(s) where the conviction(s) occurred:

0/300
Note: A conviction will not necessarily disqualify you from employment. Factors such as the nature of the offense, the time that has passed, and its relevance to the position will be considered.
Can you obtain and maintain an Arizona Fingerprint Clearance Card?
Page 1/6

Applicant Information

Growth Ability Services
Full Name

First NameMiddle NameLast Name
Address

Street Address INCLUDING APT, UNIT or TRLR (for example, 123 E Pine St Apt 245)

Street Address Line 2

CityState

Zip Code
Phone Number
Format: (000) 000-0000.
Email
example@gmail.com
Re-Enter Email
example@gmail.com
Verified Email
example@example.com
**Email addresses do not match**
Date of Birth

MonthDayYear
I certify that:
Social Security Number
Position applying for:
Date available to begin:

MonthDayYear
How many hours can you work weekly?
When do you wish to work?
School Name
Highest Level Completed
High School Diploma, Associates, Bachelors, etc.
City and State
End Year
Have you served in the Armed Forces / National Guard?
Did someone refer you?
Name of the person that referred you:
Do you have a member you would like to refer to Growth Ability Services?
Page 2/6

Work Experience

Growth Ability Services
Beginning with your most recent job, please list your work experience totaling at least two years.
EMPLOYER 1 Name
Are you currently employed here?
Position
Start Date

MonthDayYear
End Date

MonthDayYear
City and State
Duties, Skills and/or Promotions

0/200
Employer 1 Experience
Experience 1
Minimum required experience is 2 years. Please add a second employer to fulfill the 2 years of experience.
EMPLOYER 2 Name
Position
Start Date

MonthDayYear
End Date

MonthDayYear
City and State
Duties, Skills and/or Promotions

0/200
Employer 2 Experience
Experience 1 and 2
Minimum required experience is 2 years. Please add a third employer to fulfill the 2 years of experience.
EMPLOYER 3 Name
Position
Start Date

MonthDayYear
End Date

MonthDayYear
City and State
Duties, Skills and/or Promotions

0/200
Employer 3 Experience
Experience 1, 2 and 3
Minimum required experience is 2 years. Please add a fourth employer to fulfill the 2 years of experience.
EMPLOYER 4 Name
Position
Start Date

MonthDayYear
End Date

MonthDayYear
City and State
Duties, Skills and/or Promotions

0/200
Employer 4 Experience
Experience 1, 2, 3 and 4
Page 3/6

References

Growth Ability Services
Please list three references. Exclude family members or people that reside in your same address.
REFERENCE 1 Full Name
Phone Number
Format: (000) 000-0000.
What's your relationship to this person?
REFERENCE 2 Full Name
Phone Number
Format: (000) 000-0000.
What's your relationship to this person?
REFERENCE 3 Full Name
Phone Number
Format: (000) 000-0000.
What's your relationship to this person?
Page 4/6

Interview Questionnaire

Growth Ability Services
Why are you interested in this position?

0/150
Why are you interested in working with Growth Ability Services?

0/150
Describe a challenging/stressful work situation and how you handled it.

0/150
If you're running late to a member’s home or event, what would you do?

0/150
Do you have any family members or friends that have any developmental disabilities? If so, what is your relationship like?

0/150
Do you have any questions?

0/150
Page 5/6

Disclosure

Growth Ability Services
I certify that all answers and statements on this application are true and complete to the best of my knowledge. I understand that, should this application contain any false or misleading information, my application may be rejected or my employment with this company terminated.
Applicant Signature
Date

MonthDayYear
Page 6/6
Should be Empty:

New Hire Application

Applicant Information

Work Experience

References

Interview Questionnaire

Disclosure