The Arc of Atlantic County

Employment Application:

Thank you for your interest in The Arc of Atlantic County. For employment consideration, please complete the fields below.
First Name:
Last Name:
Name:*

First NameMiddle NameLast NameSuffix
Position applied for:*
Choose One:*

Full TimePart Time
Availability:

3 pm - 11 pm11 pm - 9 amFlexible
Referral Source:*

The Arc WebsiteWalk-InInternet Job SiteEmployment AgencyReferred by Friend or FamilySocial MediaReferred by Employee of The Arc
List any relatives currently employed by The Arc and your relationship.*
Have you previously applied with us?*

YesNo
If yes, when?
Are you currently employed?*

YesNo
If yes, may we contact your current employer?*

YesNo
Applicant Information:

Please complete the fields below. You will have the opportunity to attach your resume at the end of this application. All employees must be at least 18 years old.
Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number:*

Area CodePhone Number
Email:*
Are you at least 18 years of age?*

YesNo
Last 4 digits of your Social Security*
Do you possess a valid NJ driver's license (not probational or provisional)?*

YesNo
Exp. Date:*
Do you have 5 points or less on your driving record?*

YesNo
Education:

Please list any high school and/or higher education institutions you have attended. Include the name of the school, degree sought (if applicable), and graduation status.
EDUCATIONAL BACKGROUND:
A. List last three (3) schools attended, including high school: B. List number of years completed; C. Indicate degree, diploma earned, if any; Proof of degree/diploma/GED required.

	A. Name of School	B. Years Completed	C. Degree Sought	D. Graduated Y/N
High School
College
College

Employment History:

Please list your last four employers, military experience, or relevant volunteer activities, starting with the most recent.
Employer #1

This is your current or most recent employer.
Employment History
List your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military experience. Explain any gaps in employment in comments section below.
Company:*

NameTelephone
Position:*

	Start Date	End Date	Reason for Leaving
How long were you employed here?

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor (Name & Title):*
May we contact this employer?*

YesNo
Summarize your work responsibilities:*
Reason for leaving*
Employer #2

If not providing a second employer, please put N/A in the following fields: Company, Position, "How long were you employed here?" box.
Company:*

NameTelephone
Position:*

	Start Date	End Date	Reason for Leaving
How long were you employed here?

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor (Name & Title):
May we contact this employer?

YesNo
Summarize your work responsibilities:
Reason for leaving
Employer #3

If not providing a third employer, please put N/A in the following fields: Company, Position, "How long were you employed here?" box.
Company:*

NameTelephone
Position:*

	Start Date	End Date	Reason for Leaving
How long were you employed here?

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor (Name & Title):
May we contact this employer?

YesNo
Summarize your work responsibilities:
Reason for leaving
Employer #4

If not providing a fourth employer, please put N/A in the following fields: Company, Position, "How long were you employed here?" box.
Company:*

NameTelephone
Position:*

	Start Date	End Date	Reason for Leaving
How long were you employed here?

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor (Name & Title):
May we contact this employer?

YesNo
Summarize your work responsibilities:
Reason for leaving
Additional Details:

Please explain any gaps in employment and/or other work-related information you would like us to consider.
References:

Please provide three work or professional references (not related to you and not previous supervisors). If not applicable, you may list three school or personal references.
REFERENCES: List name and telephone number of three business/ work references that are not related to you and are not previous supervisors. If not applicable, list three school or personal references that are not related to you.

	Name	Phone	Years Known
Reference #1
Reference #2
Reference #3

Background:

As this agency serves people with developmental and intellectual disabilities, The State of New Jersey Department of Human Services requires employees to submit to fingerprinting and a Child Abuse Record Information (CARI) check.
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status is required upon employment).*

YesNo
Have you ever been civilly or criminally liable of a crime against a person with a developmental or intellectual disability in the state of NJ?*

YesNo
Have you ever pled "guilty" or "no contest" to, or been convicted of any crime?*

YesNo
Answering "yes" to this question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness, and nature of the violation, rehabilitation, and position applied for will be taken into account.
Consents & Agreements:
AGREEMENTS*

This serves as notice that The Arc of Atlantic County requires results of a satisfactory drug and alcohol screening test prior to beginning employment. Thereafter, tests will be performed on a random basis and will be conducted at a local medical site. Under the State of NJ Department of Health regulations, positive results for any controlled substance or illegal drug, may preclude you from employment consideration and/or may result in immediate termination of employment. Your acceptance and signature below indicates acknowledgement of this policy.
I AGREE*

Some positions require completion of a confidential survey prior to consideration for a position. This survey is used as a tool and results will be used when determining if an applicant will continue to the interview process.
I AGREE*

I give the Agency the right to investigate all references and to secure additional information about me, if job related (ex: driver history, State Registry list, etc.). I hereby release from liability the Agency and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information. It is understood and agreed that any misrepresentation by any in the application will be sufficient cause for cancellation of this application and/or termination from the company’s service if I have been employed.
I AGREE*

The Agency is an equal opportunity employer. The Agency does not discriminate in employment and no question on this application is used for the purpose of limiting or excluding any applicant’s consideration for employment on a basis prohibited by local, state or federal law.
I AGREE*

This application is current for only (60) days. At the conclusion of this time, if I have not heard from the Agency, and still wish to be considered for employment, it is necessary for me to fill out a new application.
I AGREE*

By signing below, I understand and agree that The Arc of Atlantic County makes no representation that employment with the Agency is a guarantee of continued employment. I further understand that my employment will be on an at-will basis, and that neither I, nor the company, or its representatives, have entered into a contract regarding the duration of my employment. Both The Arc and I are free to terminate my employment with The Arc of Atlantic County at any time, with or without cause or advanced notice. I further understand that no representative of the Agency has the authority to make or imply any assurances to the contrary.
Full Name:*

First NameMiddle NameLast Name
Signature:*

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The Arc of Atlantic County is an Equal Opportunity Employer. We consider applicants for all positions without regard to race, color, religion, sex, sexual orientation, national origin, age, marital or veteran status, the presence of a non-job related medical condition or disability, or any other legally protected status.
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Employment Application:

Applicant Information:

Education:

Employment History:

Employer #1

Employer #2

Employer #3

Employer #4

Additional Details:

References:

Background:

Consents & Agreements: