Employment Application Part 2

This is the second 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.

* Full name (Last, First, Middle):

* Have you ever been convicted of a criminal offence?

yes

If yes, state the nature of the crime(s), when and where the instance occurred, and the disposition of the case:

* Are you currently employed?

yes

If so, may we contact your current employer?

yes

Education, Training and Experience

Please fill in where it is applicable to you.

HIGH SCHOOL:
Name and Address, Number of years completed

Did you graduate?

Yes

COLLEGE/UNIVERSITY:
Name and Address, Number of years completed, list any degrees or diplomas you received.

OTHER EDUCATION/TRAINING:
Name and Address, Number of years completed, list any degrees or diplomas.

FOREIGN LANGUAGE:
Some IMAGINE clients may speak languages other than English. If you speak, write and understand any foreign languages, please list them below. If you do not, please write "none".

Do you have any other experience, training, qualifications or skills which you feel make you especially well-suited for work at IMAGINE? (If so, please explain)

Employment History

List below all present and past employment starting with your most recent employer (last 10 years is sufficient). Account for all periods of unemployment. You must complete this section even if you are submitting a resume.

* For each job, please list the following:
- Name of Employer, Address & Phone Number
- Type of Business
- Your Supervisor's Name
- Your Position and Duties
- Dates of Employment
- Starting and Ending Salary
- Your Reason for Leaving
- Please indicate if we may contact each employer

Current or most recent employer:

MILITARY SERVICE:
Have you obtained any special skills or abilities as the result of service in the military? If yes, please describe below.

References

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

* Reference #1
(Name, Address, Telephone, Occupation, Number of years acquainted)

* Reference #2
(Name, Address, Telephone, Occupation, Number of years acquainted)

* Reference #3
(Name, Address, Telephone, Occupation, Number of years acquainted)

Please read carefully, Click the check-box for each Paragraph, and Submit to complete your Employment Application.

* I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

Yes, I agree.

* I hereby authorize IMAGINE to thoroughly investigate my references, work record, education, and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to IMAGINE any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

Yes, I give my authorization.

* I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company’s president.

Yes, I understand.

This completes the application for employment at Imagine SLS. Please click below to submit your information.

* Indicates Response Required