Describe any training received relevant to the position for
which you are applying:
Have you ever been convicted of a criminal offense against
civil or military law, forfeited bond or collateral, or are
there criminal charges currently pending against you?
(Exclude minor traffic violations or any offense settled in
juvenile court or under a Youth Offender Law):
Yes
No
If
“Yes”, you must attach a list of all convictions and/or
charges and an explanation of each one
References:
Please provide three references, one professional, and two
personal references you have known for two years or more and
to whom you are not related.
Employment History:
Please give accurate and complete employment history
including full and part time employment. Please start with
your present or most recent employer.
Company
Name:
Phone:
Address:
Date Started:
Date Ended:
Name of Supervisor:
Pay Rate Started:
Ending:
Job Title:
Reason for Leaving:
Description of Job:
Company
Name:
Phone:
Address:
Date Started:
Date Ended:
Name of Supervisor:
Pay Rate Started:
Ending:
Job Title:
Reason for Leaving:
Description of Job:
Read
Before Submitting:
I understand that, if hired,
my employment will be “at will” and could be terminated at
any time by either party with or without cause or notice. As
a prerequisite to my employment, I understand that Arc of
New London County, Inc. will complete a criminal background,
sex offender, DMR registry check and a Department of
Transportation Drug Screen I understand that convictions
for certain offenses can result in immediate discharge. I
certify that the statements I have given are true and
correct to the best of my knowledge. I understand that
submission of any false information or the omission of any
requested information in connection with my application for
employment, whether on this document or not, may be cause
for failure to hire or for immediate discharge should I be
employed.
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