Have you ever been convicted of, pled guilty, had prosecution deferred, or plead no contest, to a felony or misdemeanor or been a founded perpetrator in any incident(s) involving the mistreatment, molestation, abuse, neglect or exploitation of a child (or children)? Include convictions of DUI/DWI and driving with a suspended license. (Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offence, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense the position(s) applied for may, however, by considered.)
You are not required to disclose any erased, expunged, or pardoned convictions.
If yes, when:
Please explain circumstances:
Name of School
Did you graduate?
If no, # of years left to graduate
If yes, date of graduation
Please list all Professional Organizations and Associations:
Please list all Professional Certification and Licensure (organization, type, expiration):
Please list technical skills, clerical skills, trade skills, etc., relevant to this position. Include relevant computer systems and software packages of which you have a working knowledge, and note your level of proficiency (basic, intermediate, expert)
Please list at least two previous employers even if you have provided a resume. Please take your time completing this section of the applicatoin. The information provided by you in this section will be used to qualify you for employment. Failure to do so will limit your ability for employment.
EQUIVALENT WORK HISTORY SECTION
Indicate the specific job in your work history; equivalent to the position being applied for.
Your full completion of the application will be the basis for employment consideration.
If no, describe the functions that cannot be performed (Note: Company complies with the ADA and consider reasonable accommodation measures that may be neccessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.)
Please provide four professional references (i.e. Supervisors, Co-workers, Teachers, etc.)
Carefully Read this Section Prior to Providing Acknowledgement Below.
I hereby affirm that information provided within this application, accompanying resume and all other supplemental information is true and complete. I acknowledge that any false or otherwise misleading representations or omissions made on said documents may disqualify me from further consideration for employment and may result in discharge even if discovered at a later date.
I understand that employment may be conditioned upon successfully passing a medical examination, and post-hire drug screen as a condition of employment. Additionally, I understand that a criminal background review and drivers motor vehicle report may be obtained to satisfy employment requirements.
I hereby authorize persons, schools, current employers, previous employers and organizations to provide Sequel Youth and Family Services and/or affiliates with any requested information pertaining to my application or suitability for employment. I release all such persons or entities from any and all liability related to the providing or use of such information.
I understand that my employment is at-will which means that I am free to terminate the employment relationship at any time and for any reason with or without notice, and that the facility has the same right. I understand that no one has the authority to enter into any contrary agreement to the proceeding sentence, except for a written agreement signed by Sequel Youth and Family Services' Chief Executive Officer and notarized.
My typed name below shall have the same force and effect as my written signature.