Employment Application

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"*" indicates required fields

Contact Information

Name*

First Last

Have you ever used another name?*

Yes

Names Used

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Have you previously applied for employment with us?*

Yes

If Yes: Month and Year

MM slash DD slash YYYY

Location*

Position applying for*

Pay Expected*

Are you available for full time work?*

Yes

If not, what days/hours can you work?*

Available for overtime?*

Yes

When are you able to start?*

MM slash DD slash YYYY

Do you have relatives or friends who are board members, employed by or receive services from The Arc of Ventura County?*

Yes

If Yes, Name & Relationship, one per line.

Referral - Mark all that apply*

Walk-In

Employment Agency

EDD/State Job Service

Employee Referral (Specify Below)

School (Specify Below)

Other company referral (Specify Below)

Other (Specify Below)

Specify Referral

Education (High School)*

Number years completed*

Did you graduate?*

Yes

Degree or Diploma*

Employment History - Please give an accurate and complete employment record.

Please list ALL employers. Add up to 4 employers below using the + button.

Employer - Company Name

Phone

Supervisor Name

Address

Street Address Address Line 2 City State ZIP Code

Date Started

MM slash DD slash YYYY

Date Ended

MM slash DD slash YYYY

Title/Duties

Reason for Leaving

May we contact this employer?

Yes

Special Skills & Qualifications

Summarize any training or special job-related skills and qualifications you may have that may be relevant to the position for which you are applying*

Give name, address and telephone number of at least three references who are not related to you and are not previous employers

Please add 3 referrals below using the + button.

Referral Name*

Phone

Address*

Street Address Address Line 2 City State ZIP Code

Equal Employment Opportunity Employer

The Arc of Ventura County provides equal employment opportunities to all employees and qualified applicants for employment and prohibits discrimination on the basis of race, color, national origin or ancestry, age, religion, creed, physical or mental disability, medical condition, sex, sexual orientation, gender identity, genetics, marital status, pregnancy, citizenship, military status, or any other characteristic protected by federal, state or local law, except where a bona fide occupational qualification applies. This policy applies to recruitment, selection, placement, training, promotion, demotion, compensation and benefits, work schedules and job assignments, social and recreational programs, transfer, layoff and recall, termination, and all other aspects of employment.

Equal Employment Opportunity Employer - Initial to Acknowledge*

Background and Reference Check

As part of its employment screening and selection procedures, The Arc of Ventura County requires background and reference checks for employees. Furnishing the information requested is mandatory. Failure to provide the information may delay or prevent completion of the application process. All applicants must complete a separate application. In determining an applicant's suitability for employment where the applicant has criminal convictions on his/her record, consideration will be given to the specific duties of the position and the nature of the offense(s). Misrepresentation, falsification, or material omission of information in this application may result in the failure to receive an offer, or if hired, dismissal from employment.

Drug & Alcohol free workplace

The Arc of Ventura County maintains a Drug & Alcohol Free Workplace. All offers of employment are contingent upon a successful pre-employment drug screen. Refusing to consent to a pre-employment drug screen is considered a voluntary withdrawal from the employment process.

Drug Free Workplace Initial to Acknowledge*

Pre-Employment Physical

All offers of employment with The Arc of Ventura County are contingent upon successful results of a medical physical which determines the ability to perform the essential duties of the position and includes a TB test.

Pre-Employment Physical Initial to Acknowledge*

At-Will Policy

Employment with The Arc of Ventura County is "at will." This means that both the agency and the employee have the right to terminate the employment relationship at any time, with or without prior notice or cause, for any reason not expressly prohibited by law. Nothing in this document or any agency document should be understood as creating guaranteed or continued employment, a requirement that "cause" exist before termination, or any other guaranteed or continued benefits. The At-Will relationship can be changed only by an express individual written employment agreement signed by the Chief Executive Officer.

At-Will Policy Initial to Acknowledge*

Upload your resume here

Choose File*

Max. file size: 50 MB.

Certification and Signature

I hereby certify that the information contained in this application form is true and correct to the best of my knowledge. I understand that any misrepresentation, falsification, or material omission of information on this application or on my resume may result in rejection of the application or termination of my employment, if hired. In connection with my suitability for employment, I authorize The Arc of Ventura County to check all personal and employment references.

Name*

First Last

Date*

MM slash DD slash YYYY

When you click the submit button below your information for your application will be submitted. You will then be redirected to the Voluntary Information Form. We ask that you fill that out this form for governmental reporting purposes. The information is used for reporting to governmental agencies only. It is not used in determining eligibility for employment and is kept separate from the application form.

Employment Application

Unable to complete this form now? Save your progress!

Contact Information

Employment History - Please give an accurate and complete employment record.

Special Skills & Qualifications

Give name, address and telephone number of at least three references who are not related to you and are not previous employers

Equal Employment Opportunity Employer

Background and Reference Check

Drug & Alcohol free workplace

Pre-Employment Physical

At-Will Policy

Upload your resume here

Certification and Signature

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