Form Testing

Employment Desired

Education

List any seminars, classes, or other education which may help you qualify for this position.

Employment History

List below all present and past employers over the past ten years, starting with your most recent employer. Account for all periods of unemployment.

Employer:

Employer:

Employer:

Additional Information Continued

Do you speak any languages other than English?

Personal or Professional References

List below three persons not related to you who have knowledge of your work performance within the last 5 years

Investigation Authorization:

I authorize investigation into all statements and references contained in this application. Said investigation may include interviews with past employers, workers, and friends. Said investigation may include credit, driving, criminal background, drug screenings, references, and other background checks. As a condition of applying for this job, I authorize reasonable post-offer investigations into my credit, driving and criminal background. I authorize the references and contacts listed to provide the agency with any and all relevant information, personal or otherwise, and to the fullest extent allowed by law, I release all parties from all liability for any damages that may result from furnishing the same to the agency.

Company Obligation:

I understand and agree that the Company’s acceptance of this job application does not mean that a position for which I am qualified is open (unless specifically posted) or that the company has agreed to hire me. I understand that the Company is under no obligation to hire me as the result of accepting this completed application.

Fingerprints:

I authorize investigation into all statements and references contained in this application. Said investigation may include interviews with past employers, workers, and friends. Said investigation may include credit, driving, criminal background, drug screenings, references, and other background checks. As a condition of applying for this job, I authorize reasonable post-offer investigations into my credit, driving and criminal background. I authorize the references and contacts listed to provide the agency with any and all relevant information, personal or otherwise, and to the fullest extent allowed by law, I release all parties from all liability for any damages that may result from furnishing the same to the agency.

Driver’s License, DMV History & Vehicle Insurance

Both agencies require driving for agency business; therefore, all applicants must have a valid CA Driver’s License (2 years minimum) clean Driving Record and provide proof of valid auto insurance. Applicants must be considered an acceptable driver by the agency’s insurance carrier. If an applicant is uninsurable by the agency’s carrier, the applicant cannot be employed by the agency.

First Aid/CPR

All Direct Service Staff are required to successfully complete, a First Aid/CPR training course arranged and provided by employer. Staff who fail to meet this requirement may not work again until they have successfully completed the training. Employer covers the cost.

Proof of Right to Work:

At time of hire you will be required to present proof of your right to remain and work in the U.S.A.

Arbitration:

You understand that, if offered employment, you will be required to sign an agreement requiring you to arbitrate almost all claims you might have against the agency in the future. You hereby agree to submit to binding arbitration all disputes and claims arising out of the submission of this application in accordance with the terms of that Agreement.

I CERTIFY UNDER PENALTY OF PERJURY PURSUANT THE LAWS OF THIS STATE THAT MY ANSWERS ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. I AM AWARE THAT FAILURE TO COMPLETE THIS APPLICATION, INTENTIONAL OMISSIONS OR MISSTATEMENTS MAY RESULT IN REFUSAL OF EMPLOYMENT OR DISCHARGE. I UNDERSTAND IF HIRED, MY EMPLOYMENT WILL BE “AT-WILL,” FOR NO DEFINITE OR SPECIFIC PERIOD OF TIME AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, FOR ANY RESON OR FOR NO REASON AT ALL, WITH OR WITHOUT PRIOR NOTICE AT THE OPTION OF THE AGENCY OR ME. I ALSO UNDERSTAND THAT OFFERS OF EMPLYMENT MAY BE CONTINGENT ON A SATISFACTORY BACKGROUND CHECK, INCLUDING A REVIEW OF MY CRIMINAL HISTORY. I HAVE READ AND UNDERSTAND THE ABOVE POLICY STATEMENTS AND AGREE TO BE BOUND BY THEM IF EMPLOYED BY THE COMPANY.