Application for Employment at Community Autism Resources, Inc.
For which position are you applying ?
Please Select
Autism Waiver Broker Supervisor
PERSONAL INFORMATION
Full Name
*
First Name
Middle Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
E-mail
*
Primary Phone Number
*
-
Area Code
Phone Number
EDUCATIONAL BACKGROUND
School Name
*
Major
*
Degree
*
Status
Please Select
Graduated
Currently Attending
Additional School Information
School Name
Major
Degree
Status
Please Select
Graduated
Currently Attending
EMPLOYMENT HISTORY
Are you currently employed?
*
Please Select
Yes
No
May we contact your current employer?
Please Select
Yes
No
Employer Name
Job Title
Start Date (mm/yyyy)
End Date (mm/yyyy) (leave blank if stilled employed)
Additional Employment History
Employer Name
Job Title
Start Date (mm/yyyy)
End Date (mm/yyyy) (leave blank if stilled employed)
Have you ever filed an application with us before?
*
Please Select
Yes
No
Have you ever been employed with us before?
*
Please Select
Yes
No
Are you prevented from becoming employed in this country because of Visa or Immigration Status?
*
Please Select
Yes
No
On what date would you be available for work (mm/dd/yyyy)?
*
Are you available to work (check all that apply)
*
Full Time
Part Time
Are you currently on "lay-off" status and subject to recall?
*
Please Select
Yes
No
Do you have a valid driver's license?
*
Please Select
Yes
No
Do you have any relatives that currently work at Community Autism Resources, Inc.?
*
Please Select
Yes
No
PROFESSIONAL REFERENCES
Please provide the following information for three references. Including email address will help us to complete the evaluation process.
Reference #1
Full Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Relationship
*
Reference #2
Full Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Relationship
*
Reference #3
Full Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Relationship
*
Please upload your cover letter and resume below.
*
THE STATEMENTS BELOW ARE PART OF THE APPLICATION AND SHOULD BE READ CAREFULLY. I authorize all persons, schools, employers and organizations mentioned in this application to provide Community Autism Resources, Inc. with any and all information requested by Community Autism Resources, Inc. and I voluntarily release all such persons, schools, employers and organizations from all liability for providing such information. In the event I am employed by Community Autism Resources, Inc., I agree to comply with all its rules, regulations, directives and policies. I also release and indemnify Community Autism Resources, Inc. against any liability which might result from requesting reference information. I understand that any offer of employment is conditional on a satisfactory CORI (Criminal Offender Record Information) check and may require a satisfactory driving record check and other criminal background checks. I understand that no offer of employment is binding unless made in writing by the Executive Director, that any employment is for no stated term, and that the employment relationship may be terminated by me or Community Autism Resources, Inc. at any time. I hereby affirm that the information provided by me in this Application for Employment/Volunteerism or Internship, any other required documents or forms, and the interview process is true and complete. I understand that any false information or material provided or omitted by me may disqualify me from further consideration for employment/service and may result in discharge/release if discovered at a later date. By electronically submitting this application, I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application information.
*
I agree to all the terms and conditions.
Submit
Should be Empty: