ABLE, Inc - Employment Application - STEP 1 OF 2

After completing this application, you will be redirected to http://www.talentmanagementplus.com/login.php?jobcode=2046VLH to complete step 2 of 2. If you get disconnected after clicking submit, be sure to visit the site to complete the process.

We are an equal opportunity employer, dedicated to a policy of nondiscrimination on any basis including race, color, religion, creed, national origin, age, veteran status, marital status, citizenship, disability, or any other characteristics protected under the law.

Name: * First Last
Address: *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Email: *
Phone: * - (###) - ### ####
Other phone: - (###) - ### ####
Position applying for: *
Minimum acceptable salary: *
If considered for employment, what date can you start? * / MM / DD YYYY
Do you have a valid drivers lcense? * Yes No
Have you ever applied for employment with ABLE, Inc.? * Yes No
If so, when?
Were you previously employed by ABLE, Inc.? * Yes No
If so, when?
Are you related to anyone presently employed or receiving services with ABLE, Inc.? * Yes No
Comments:
Are you legally eligible for employment in the USA? (Proof of citizenship or immigration status will be required upon employment.) * Yes No
AVAILABILITY INFORMATION
Are you available to work: * Full-time Part-time Backup As needed by ABLE, Inc.
ABLE, Inc. operates 24-hours per day, 365 days per year. Are you willing to work a nonstandard work week? * Yes No
Comments:
EDUCATION AND/OR TRAINING
Circle highest grade completed:
High School: 9 10 11 12
If not a high school graduate, do you have a certificate of equivalency? Yes No
College: 1 2 3 4
Graduate School: 1 2 3 4
College, university, vocational, business, nursing, or any other school you have attended:
Name and Location:
From: / MM / DD YYYY
To: / MM / DD YYYY
Degree:
Date granted: / MM / DD YYYY
Name and Location:
From: / MM / DD YYYY
To: / MM / DD YYYY
Degree:
Date granted: / MM / DD YYYY
Name and Location:
From: / MM / DD YYYY
To: / MM / DD YYYY
Degree:
Date granted: / MM / DD YYYY
Volunteer experience:
EMPLOYMENT HISTORY
Name of business:
City & State:
Phone: - (###) - ### ####
From: / MM / DD YYYY
To: / MM / DD YYYY
Position:
Duties:
Salary:
Name of immediate supervisor: First Last
Reason for leaving:
May we contact the employer? Yes No
If no, reason:
Name of business:
City & State:
Phone: - (###) - ### ####
From: / MM / DD YYYY
To: / MM / DD YYYY
Position:
Duties:
Salary:
Name of immediate supervisor: First Last
Reason for leaving:
May we contact the employer? Yes No
If no, reason:
Name of business:
City & State:
Phone:
From: / MM / DD YYYY
To: / MM / DD YYYY
Position:
Duties:
Salary:
Name of immediate supervisor: First Last
Reason for leaving:
May we contact the employer? Yes No
If no, reason:
REFERENCES
Name: First Last
Address:
Phone: - (###) - ### ####
Relationship:
Name: First Last
Address:
Phone: - (###) - ### ####
Relationship:
BACKGROUND INFORMATION
Answering yes will not disqualify you from potential employment.
Have you ever been convicted, plead guilty or plead no contest to an offense other than a minor traffic violation? (Including, but not limited to, abuse, neglect or exploitation of another person.) * Yes No
If yes, indicate date for each violation, nature of charge, and sentence received:
Has Social Services ever determined you were responsible for Abuse, Neglect or Exploitation towards another person? * Yes No
If yes, please explain:
**ABLE, Inc. is required to conduct background checks on all employees of ABLE, Inc.
Upload résumé:
By selecting "I agree," I certify that the facts contained in this application (and accompanying resume, if any) are true, correct and complete. I understand that any false statement, omission, or misrepresentation on this application or in any interview is sufficient cause for refusal to hire or dismissal if I have been employed, no matter when discovered by ABLE, Inc. I further understand the employment application and other employment related documents are not contracts of employment; also, any oral or written statements to the contrary are expressly disavowed. I further understand and agree that if I am hired, my employment will be “at-will” and without fixed term, and may be terminated at any time, with or without prior notice, at the option of either myself or ABLE, Inc. In addition, I hereby consent to the release of information requested by ABLE, Inc. regarding a reference check of my employment. * I agree
Date * / MM / DD YYYY

ABLE, Inc - Employment Application - STEP 1 OF 2

ABLE, Inc - Employment Application - STEP 1 OF 2

AVAILABILITY INFORMATION

EDUCATION AND/OR TRAINING

College, university, vocational, business, nursing, or any other school you have attended:

EMPLOYMENT HISTORY

REFERENCES

BACKGROUND INFORMATION Answering yes will not disqualify you from potential employment.

**ABLE, Inc. is required to conduct background checks on all employees of ABLE, Inc.

BACKGROUND INFORMATION
Answering yes will not disqualify you from potential employment.