Building Bridges Developmental and Community Services Employment Application

EMPLOYMENT APPLICATION

BUILDING BRIDGES DEVELOPMENTAL AND COMMUNITY SERVICES, INC.
Building Bridges Developmental and Community Services, Inc. is an Equal Opportunity Employer. Race, color, religion, age, sex, disability, marital or veteran status, place of national origin and other categories protected by law are not factors in employment, promotion, compensation or working conditions.

APPLICATIONS ARE RETAINED 1 YEAR FROM THE DATE SIGNED

___________________________________________________________________________________
Date

Month Day Year
Full Name *

First Name Middle Name Last Name
Social Security Number *
E-mail *
Address

Street Address

Street Address Line 2

City State

Zip Code
Phone Number *

Area Code Phone Number
Message Number

Area Code Phone Number
Are you at least 18 years of age or older? *

Yes No
Do you have a valid Driver's License: *

Yes No
License Number and State Issued *

EDUCATION
HIGH SCHOOL
Name of School
Address

Street Address

Street Address Line 2

City State

Postal / Zip Code
Did you graduate?

Yes No Attending
COLLEGE OR UNIVERSITY
Name of College
Address

Street Address

Street Address Line 2

City State

Postal / Zip Code
Course of Study/ Degree Earned
Did you graduate?

Yes No Attending
OTHER EDUCATION
Name of College/Technical School or University
Course of Study/ Degree Earned
Did you graduate?

Yes No Attending

I, hereby give consent to any and all prior employers of mine, or any
current employer, to provide the information below regarding my employment to Building Bridges Developmental and Community Services, Inc.
This consent is valid from the date indicated below till application expires. A copy of this form shall serve as an original.
Signature

Clear
Name

First Name Last Name
INSTRUCTION TO CURRENT OR FORMER EMPLOYER
The individual named above has applied for employment with Building Bridges Developmental and Community Services, Inc. Please respond candidly to the request for information listed below and return your written response via fax to: 501-676-0697.

The consent and Release is intended to comply with 11-3-204 of the Arkansas Code, a law providing current and former employers with protection for providing job information about current or former employees to prospective employees.

Date and duration of Employement:

Current or last job description and duties:

The details of the applicant's last written performance evaluation prepared prior to the date of applicant signed this consent:

Attendance history (excluding any qualifying leave under FMLA)

Results of drug and/or alcohol tests administered within the last year:

Was his/her separtation from employment voluntary or involuntary:

What was the reason the applicant's separation from employment:

Is this applicant eligible for re-hire? YES NO NO (per company policy)

Current of past employer's signature, title and date:
Signature

Clear

Employment History

List below all previous employers starting with the current or most recent position for the past 10 years.
Employer Name
Address

Street Address

Street Address Line 2

City State

Zip Code
Employer phone

Area Code Phone Number
Supervisor name

First Name Last Name
Position Held
Start date

Month Day Year
Date Finished

Month Day Year
Describe your duties:
Reason for leaving
HUMAN RESOURCE USE ONLY

Reference Verified

Date

By

Comments

Employment History
Employer Name
Address

Street Address

Street Address Line 2

City State

Zip Code
Employer phone

Area Code Phone Number
Supervisor name

First Name Last Name
Position Held
Start date

Month Day Year
Date Finished

Month Day Year
Describe your duties:
Reason for leaving
HUMAN RESOURCE USE ONLY

Reference Verified

Date

By

Comments

Employment History
Employer Name
Address

Street Address

Street Address Line 2

City State

Zip Code
Employer phone

Area Code Phone Number
Supervisor name

First Name Last Name
Position Held
Start date

Month Day Year
Date Finished

Month Day Year
Describe your duties:
Reason for leaving
HUMAN RESOURCE USE ONLY

Reference Verified

Date

By

Comments

Please read each paragraph carefully. Select either "YES" if you agree or "NO" if you do not agree.

If there is any part of the paragraph that you do not understand select "no".

I hearby autorize Building Bridges to thoroughly investigate my references, work records, education and other matters related to my suitability for employment and, further, authorize my current and former employers to disclose to the company 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.
I understand and agree. *
I understand that if offered employment, the offer may be contingent on my passing a pre-employment alcohol and drug screen Initial and a pre-employment physical. By signing this application, I voluntary agree to submit to a pre-employment drug screen and a pre-employment physical. I understand that failure to pass the alcohol/drug screen and/or physical will result in withdrawal of the employment offer.
I understand and agree. *
If hired, I also agree to submit to alcohol or drug testing as a condition of employment. I agree the Building Bridges Developmental and Community Services, Inc. may conduct alcohol or drug screening to its sole discretion with or without notice. I also understand that refusal to submit to an alcohol or drug screen will be considered a voluntary resignation of employment.
I understand and agree. *

I understand that nothing contained in the application or conveyed to me during any interview, which may be granted, is intended to create an employment contract, implied or explicit, between me and Building Bridges Developmental and Community Services, Inc. In addition, I understand and agree that if I am employed, my employment relationship with Building Bridges Developmental and Community Services, Inc. is strictly voluntary and at our mutual will.
I understand and agree. *
I understand and agree that any future changes in my title, duties, compensation, working conditions, and/or Building Bridges Developmental and Community Services, Inc. benefits, policies and procedures will not alter our at-willl and arbitration agreements.
I understand and agree. *
I understand that if offered employment, I will, as a condition of employment, be required to submit proof of my identity and legal right to work in the United States on my first day of employment.
I understand and agree. *
If the position applied for requires driving in the course of work, I understand that I will be required to possess a current and valid Initial Arkansas driver's license and understand that I will be required to provide a copy of my official driving record and proof of insurance. I also understand that any offer of employment is contingent on my ability to be covered by Building Bridges Developmental and Community Services' auto insurance as required for my position.
I understand and agree. *

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 on this application or on any documents 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.
I understand and agree. *
Electronic Signature *

Clear
Please list (3) personal references that are not a former employer or a relative.
(1) Reference *

First Name Last Name
Phone Number *

Area Code Phone Number
(2) Reference *

First Name Last Name
Phone Number *

Area Code Phone Number
(3) Reference *

First Name Last Name
Phone Number *

Area Code Phone Number
Additional Information
Attached Resume
Attach Professional License
Attach Letters of Recommendation
Have you ever been employed under a name other than the name used on this application? *

Yes No
If yes, please list any other names.
Electronic Signature *

Clear
Should be Empty:

EMPLOYMENT APPLICATION

EDUCATION

Additional Information