Work Activity Center Application for Employment

Name *
Name
Address *
Address
Home Phone *
Home Phone
Cell Phone
Cell Phone
Todays Date
Todays Date
AVAILABILITY
Please check everything you wish to be considered for *
POSITION DESIRED
Please choose the primary position you are applying for:
MINIMUM QUALIFICATIONS
QUALIFICATIONS VARY DEPENDING ON POSITION BEING SOUGHT. PLEASE SEE JOB DESCRIPTION FOR COMPLETE LIST OF MINIMUM QUALIFICATIONS.
Are you legally able to be employed in the United States of America? *
Are you at least 18 years old? *
Are you 21 years or older? *
Do you have reliable transportation? *
Do you have a valid and current Utah Driver License? *
ADDITIONAL INFORMATION
Have you ever worked at the Work Activity Center before? *
Do you have any relatives employed at the Center? *
How did you hear about us?
Please list any volunteer experence relating to people with disabilities
EDUCATION
Diploma/GED?
Degree Earned?
Degree Earned?
WORK HISTORY
PLEASE LIST YOUR LAST 3 JOB POSITIONS BEGINNING WITH YOUR MOST RECENT EMPLOYMENT
Phone Number
Phone Number
Dates Worked
Dates Worked
From
To
$
May we contact this employer? *
Phone Number
Phone Number
Dates Worked
Dates Worked
From
To
$
May we contact this employer? *
Phone Number
Phone Number
Dates Worked
Dates Worked
From
To
$
May we contact this employer? *
WORK RELATED REFERENCES
PLEASE LIST THREE WORK RELATED REFERENCES WE CAN CONTACT TO VERIFY YOUR EMPLOYMENT, VOLUNTEER, EDUCATIONAL, OR OTHER RELEVANT EXPERIENCE:
Phone Number
Phone Number
Phone Number
Phone Number
Phone Number
Phone Number
TRAINING, CERTIFICATIONS OR LICENSES
Some examples include CPR, First Aid, Food Handlers Permit, SOAR or MANDT, CNA license, etc.
CONVICTION DISCLOSURE
Have you ever been convicted of anything other than a minor traffic violation? *
Most convictions will not automatically disqualify an applicant for an offer of employment. The seriousness, date of conviction, and relation to the type of work conducted at the Center will be considered. The Work Activity Center conducts a background and criminal investigation check on all persons employed. This search is comprehensive and includes juvenile records.
PLEASE COMPLETE THE FOLLOWING STATEMENTS AND SIGN THE FORM
EQUAL OPPORTUNITY, DISCRIMINATION, AND AFFIRMATIVE ACTION POLICY
The Work Activity Center is an equal opportunity employer and does not discriminate against any persons on the basis of race, color, religion, national origin, sex, age, or disability. The Work Activity Center opposes and will not tolerate discrimination, including harassment, by or against any employees or participants in the Center’s services. The Work Activity Center does not discriminate against the above mentioned protected classes in making decisions regarding hiring, firing, training, discipline, compensation, benefits, classification, advancement or other terms of employment. *
Do you accept these terms?
POLICY ON DRUG-FREE WORKPLACE
In accordance with the Drug-Free Workplace Act of 1988, the Work Activity Center’s policy is: The unlawful manufacture, distribution, dispensation, possession, or use of a controlled substance in the Work Activity Center’s business on or off the property is prohibited. Violation of this policy will result in disciplinary action including possible termination of employment and possible legal consequences. As a condition of employment at the Work Activity Center, all applicants/employees are drug-tested at or shortly after the time of hiring. If you test positive for drug use, employment may be terminated immediately. *
Do you accept these terms?
YOUR SIGNATURE BELOW INDICATES: 1. THAT YOU UNDERSTAND AND AGREE TO ABIDE BY THE WORK ACTIVITY CENTER’S DRUG FREE WORKPLACE POLICY AS A CONDITION OF EMPLOYMENT; 2. THAT YOU AUTHORIZE THE CENTER TO OBTAIN AND VIEW SUMMARIES OF ANY CRIMINAL HISTORIES THAT MAY EXIST CONCERNING YOU FROM APPROPRIATE STATE AND FEDERAL AGENCIES FOR THE LIMITED PURPOSE OF CONSIDERING YOU FOR EMPLOYMENT WITH THE CENTER AND; 3. THAT YOU CERTIFY THAT ALL INFORMATION FURNISHED ON THIS APPLICATION FORM IS ACCURATE AND COMPLETE TO THE BEST OF YOUR KNOWLEDGE AND BELIEF. ALSO, THAT YOU UNDERSTAND THAT ANY MISREPRESENTATION OR OMISSION OF FACT, AS STATED AND/OR IMPLIED, ON THIS APPLICATION FORM OR ANY OTHER EMPLOYMENT FORM IS SUFFICIENT REASON NOT TO HIRE YOU OR MAY BE REASON FOR DISMISSAL. 4. THAT YOU UNDERSTAND THAT EMPLOYMENT WITH WORK ACTIVITY CENTER IS AT WILL, MEANING THAT EITHER THE EMPLOYEE OR THE EMPLOYER CAN TERMINATE EMPLOYMENT AT ANY TIME, WITH OR WITHOUT NOTICE, FOR ANY REASON NOT PROHIBITED BY LAW.