Imagine SLS
Employment Application Part 1 (of 2)
This is the first part of the Employment application for Imagine Supported Living Services. Please fill it out completely and accurately. All questions marked with * at the beginning are required.
*
Last Name
*
First Name
Middle Name
*
Home Phone:
Work Phone:
Social Security Number (optional):
E-mail Address:
*
Present Address (NUMBER & STREET, CITY, STATE, ZIP):
Permanent Address (NUMBER & STREET, CITY, STATE, ZIP):
Only if different from present address.
Employment Desired
*
Position applying for:
*
Are you applying for (check all that apply):
Regular full-time work
Regular part-time work
Temporary work, e.g. substitution, summer job?
*
What days and hours are you available to work?
Are you available (check any that apply):
to work on weekends
for a
live-in
position
*
If hired, what day can you start?
*
What is your desired salary?
Personal Information
*
Have you ever applied to, or worked for, IMAGINE before?
Yes
No
If yes, when?
*
Do you have any friends or relatives who have worked, or are working, at IMAGINE?
Yes
No
If Yes, state name(s) and relationship:
*
Why are you applying for work at IMAGINE?
*
If hired, would you have a reliable means of transportation to and from work?
Yes
No
*
Are you at least 18 years old?
(If under 18, hire is subject to verification that you are of minimum legal age.)
Yes
No
*
If hired, can you present evidence of your U.S. citizenship or proof of your legl right to live and work in this country?
Yes
No
*
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?
Yes
No
If no, describe the functions that cannot be performed:
You have completed Part 1 of the Employment Application. Please click the submit button and continue on to Part 2.
*
Indicates Response Required
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