Application for Employment
Equal Opportunity Employer
The Arc Upper Valley is an equal opportunity employer. It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability or other protected classifications.
Instructions
Answer all fields/questions. List N/A for anything that is not applicable. Sign and date the form before submission.
Personal Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Are you 18 years of age or older?
*
Yes
No
Are you 21 years of age or older?
*
Yes
No
Are you eligible to work in the United States?
*
Yes
No
Have you ever been employed by The Arc Upper Valley, Inc.?
*
Yes
No
If yes, under what name?
*
If yes, why did you leave your position?
*
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Position/Availability
Position Applied For
*
Please indicate the days and hours you are available to work, Sunday - Saturday.
*
What date are you able to start work?
*
-
Month
-
Day
Year
Date
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Employment History
Include all employment going back at least 10 years. If you need more space, you can attach a document or resume at the end of the application.
1. Name of Employer
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Job Title
*
Job Duties
*
Dates Employed
*
Reason for Leaving
*
If you were employed under a different name, please list here
*
May we contact for a reference?
*
Yes
No
2. Name of Employer
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Job Title
*
Job Duties
*
Dates Employed
*
Reason for Leaving
*
If you were employed under a different name, please list here
*
May we contact for a reference?
*
Yes
No
3. Name of Employer
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Job Title
*
Job Duties
*
Dates Employed
*
Reason for Leaving
*
If you were employed under a different name, please list here
*
May we contact for a reference?
*
Yes
No
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Education/Qualifications
List highest level of education, skills, and qualifications. If you need more space, you can attach a document or resume at the end of the application.
1. School/College Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Did you graduate?
*
Yes
No
Degree or Major
*
2. School/College Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Did you graduate?
*
Yes
No
Degree or Major
*
List any Licenses, Skills, Training, Awards, Military Service, Volunteer Work and Charitable Gaming Experience
*
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Background and Motor Vehicle Information
All applicants will be required to complete a background check, and if applicable, a motor vehicle record check. If you are hired, continued employment is conditional pending results of background and motor vehicle record check.
Have you ever been convicted of and/or pleaded no contest to a misdemeanor or felony?
*
Yes
No
If yes, list dates, offenses and disposition
*
Do you have a current, valid driver's license? (Required to show proof upon hire, if applicable for position.)
*
Yes
No
Have you had any violations on your driving record over the past 3 years?
*
Yes
No
If yes, please describe
*
Do you have automobile insurance on your vehicle? (Required to show proof upon hire, if applicable for position.)
*
Yes
No
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References
Please list 3 personal or professional references that you have known at least 1 year (excluding family.)
1. Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Relationship
*
2. Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Relationship
*
3. Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Relationship
*
Upload Additional Information or Resume
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Applicant Statement and Signature
I certify that the facts set forth in this Application for Employment are true and complete the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations my result in my denial of employment or if employed, termination. I authorized the Employer to make an investigation of any of the facts set forth in this application, and release the Employer from any liability. I acknowledge and understand that the company is an "at will" employer. Therefore, any employee may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.
Printed Name
*
Signature
*
Date
*
-
Month
-
Day
Year
Date
Heading
The Arc Upper Valley | 1200 South Washington Street, Grand Forks, North Dakota 58201 | (701) 772-6191 | www.thearcuppervalley.org
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