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Application for Employment

It is our policy to provide equal employment opportunities to all qualified persons without regard to race, age, color, sex, religion, 

national origin, handicap, marital status, sexual orientation or any other legally protected status.

PERSONAL INFORMATION:

Name (First, MI, Last):  
Address:  
City:  
State:  
Zip:  
Telephone Number:  
Position Applied For:  
E-mail me notification of future openings:   Yes  No    
Are you legally eligible for employment in the USA?   Yes  No    
Referral Source:
Have you ever filed an application with WAC?   Yes  No    If yes, when?   
Have you ever been employed here?   Yes  No     If yes, when?
Are there any hours, shifts, days you cannot or will not work?          Shift preferred:  Full Time    Part Time
Have you ever been convicted of a felony or misdemeanor?   Yes   No    If yes, please describe:
     A conviction will not necessarily disqualify you.  Not required to reveal sealed or expunged records.
Are you employed now?   Yes  No 
Are you on lay off? Yes   No      If yes, are you subject to recall?  Yes  No
On what date will you be available for work?  
Do you have a valid driver's license?         Yes    No
Has your license been suspended or revoked within the past five years? Yes    No  If yes, please explain:
List any traffic convictions you have had within the past seven years:

        

EMPLOYMENT:

        May we contact your present employer?  Yes    No    List in order, last or present employer first.  Please include work history for at least the past five years.

Dates employed:

to  

Employer:
 Brief Description of Work You Did:
Job Title:   Address:
Reason for Leaving: City/State/Zip:
Supervisor: Phone:

 

Dates employed:

to  

Employer:
 Brief Description of Work You Did:
Job Title:   Address:
Reason for Leaving: City/State/Zip:
Supervisor: Phone:

 

Dates employed:

to  

Employer:
 Brief Description of Work You Did:
Job Title:   Address:
Reason for Leaving: City/State/Zip:
Supervisor: Phone:

 

Dates employed:

to  

Employer:
 Brief Description of Work You Did:
Job Title:   Address:
Reason for Leaving: City/State/Zip:
Supervisor: Phone:

 

Dates employed:

to  

Employer:
 Brief Description of Work You Did:
Job Title:   Address:
Reason for Leaving: City/State/Zip:
Supervisor: Phone:

 

REFERENCES:

               Please list one personal reference (not a relative) and two job-related references:        

Name of Personal Reference:

Relationship:

Address:

Phone:

   

Name of Supervisor:

Company/Business:

Address:

Phone:
   

Name of Supervisor:

Company/Business:

Address:

Phone:

 

     

EDUCATION:

High School (Name/City/State):

 Diploma:        Yes    No

College/University (Name/City/State):

Major:

Degree:

College/University (Name/City/State):

Major:

Degree:

Other:

  

Certificates/Registrations?

  

    

                

List any other training, experience, skills including the U.S. military, which you feel would enhance your abilities to work with this agency.

List professional, trade, business, school or civic activities and offices held:

 

 Please read carefully:

    I understand that, if employed, my personnel file may be subject to review from time to time by state and federal funding agencies.

    I authorize investigation of all statements contained in this application, including checking with references, with the understanding that information obtained will be kept confidential.

    I understand that false or misleading information given in my application or interviews shall be considered sufficient cause for dismissal.

    I hereby understand and acknowledge that any employment association with Warren Achievement Center, Inc. is of an "at will" relationship and should not be construed as a contract of employment between the employer and the employee, or a promise of employment.  It is also understood that the employee may resign at any time and the employer may discharge the employee at any time with or without cause.

    I understand that if I am required to use my vehicle during the course of my employment, I will certify that I am adequately covered with liability insurance.

    I understand also, that I am required to abide by all rules and regulations of Warren Achievement Center, Inc.

    In accordance with the Drug Free Workplace Act, effective January 1, 1992, it is the policy of Warren Achievement Center, Inc., to maintain a workplace that is free from the effects of drug and alcohol abuse.  I understand that employees may be required to take a test at any time while working for reasonable suspicion, follow-up treatment and safety testing to determine the presence of drugs, narcotics, or alcohol, unless such tests are prohibited by law.

    In accordance with the Health Care Worker Background Check Act, effective January 1, 1996, it is the policy of Warren Achievement Center, Inc. to secure a criminal history record check on all new employees who provide personal care, direct care, or general supervision and oversight of the physical and mental well-being of individuals receiving services.  Employment will be considered conditional pending the results of the criminal history record check.

    Effective March 1, 1996, all new Warren Achievement Center, Inc. employees working in our child care facility who have contact with children as part of their duties are required to complete a criminal background check.  These checks are required in addition to the checks of the child abuse tracking system.  The employee may begin on a conditional basis while the background check is being conducted, but may not be left alone with children.

    Many of our consumers have lived in institutions and are highly vulnerable to communicable diseases.  Applicants for employment with Warren Achievement Center, Inc. should understand that they will be working with individuals who are considered to be at high risk for communicable diseases.

    Warren Achievement Center will follow the provisions as outlined in Public Act 95-0017 “The Smoke Free Illinois Act” effective January 1, 2008.  This act prohibits smoking in all workplaces and within 15 feet of entrances.

 

    By entering my e-mail address and clicking "Submit", I certify that the answers given on this Application for Employment are true and complete to the best of my knowledge.  I also certify that I have read and understand the above information.

My E-mail Address:

(required for acknowledgement and notification of future openings)

 

 

Send mail to info@warrenachievement.com with questions or comments about this web site or for requests for information.
Copyright © 2003-2006 Warren Achievement Center, Inc., 1220 E. 2nd Ave., Monmouth, IL 61462
Last modified: October 23, 2006