Employment Application Form

Application for Employment
By completing this application, you understand and accept that you are applying for a position as an "At Will" employee. "At Will" employment means that either you or the Company can terminate your employment with or without cause and with or without notice.
Name:

First NameLast Name
Phone Number:

Area CodePhone Number
E-mail Address:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you over 18 years of age?
Have you ever been convicted of a crime?
If "yes" please explain:
Please note, The Indiana Family and Social ServicesAdministration and the Bureau of Developmental Disabilities Services place prohibitionson employment of persons with certain criminal histories, including felonies, workingwith individuals with IDD/DD. Information regarding these restrictions can befound online at https://www.in.gov/fssa/ddrs/files/Employment_of_Persons_with_Convictions_of_Prohibited_Offenses_Non-Residency_Status.pdfPlease not
Are you availalbe to work any shift (Days, Evenings, Nights, Weekends)? Check all that apply.
Date available to begin work

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Do you have a valid Driver's License and active liability auto insurance?
Have you ever been employed by The Arc of Vigo County?
If Yes, please list position and dates
How were you referred to us?
Others:
Upload Resume:

Upload a File

Cancelof
Employment History and Job Skills
Employer Name
Supervisor Name and Phone Number
Position Held
From

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
To

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer Name
Supervisor Name and Phone Number
Position Held
From

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
To

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer Name
Supervisor Name and Phone Number
Position Held
From

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
To

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Describe your skills:
Training or Certifications:
References

Please list two (2) references that are familiar with your work life.
Reference 1
Name:

First NameLast Name
Phone Number

Area CodePhone Number
Years Known:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Reference 2
Name:

First NameLast Name
Phone Number

Area CodePhone Number
Years Known:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Signature of Applicant
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
The Arc of Vigo County, Inc. is an Equal Employment Opportunity Employer and considers all applicants without regard to race, color, religion, gender, national origin, age, marital status, veteran’s status, the presence of a mental, physical or sensory disability, sexual orientation, or any other legally protected status. Employment shall be based solely on the needs of the companies and the qualifications of the individuals making application.
Please verify that you are human
Should be Empty:

Application for Employment