Direct Support Professional – Day Program

The Arc of Fayette County
80 Old New Salem Road,
Uniontown, PA 15401
t) 724-438-9042 – f) 724-438-2405

We consider applicants for all positions without regard to race, color, religion, gender, national origin, age, disability, marital or veteran status, or any other legally protected status. WE ARE AN EQUAL OPPORTUNITY EMPLOYER.

Position(s) applied for:(Required)

Date of Application:(Required)

How did you learn about Arc, Fayette?(Required)

Newspaper Advertisement

Current/Former Employee

Referred by

Website

Other

Newspaper Advertisement (Specify):

Current/Former Employee:

Referred by:

Website:

Other (Specify):

Full Name(Required)

Address(Required)

Telephone Number(s)(Required)

Email Address(Required)

If you are under 18 years of age, can you provide required proof of your eligibility to work?(Required)

Yes

No

N/A

Have you ever filed an application with us before?(Required)

Yes

No

Have you ever been employed by us before?(Required)

Yes

No

If yes, give date:(Required)

Are you currently employed?(Required)

Yes

No

May we contact your present employer?(Required)

Yes

No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment.(Required)

Yes

No

Date available for work:(Required)

Expected salary range:(Required)

Type of work desired:(Required)

Full-time:(Required)

Yes

No

Part-time:(Required)

Yes

No

Provisional (as needed/ as available)(Required)

Yes

No

Please list your days and hours of availability:

Monday(Required)

Tuesday(Required)

Wednesday(Required)

Thursday(Required)

Friday(Required)

Saturday(Required)

Sunday(Required)

Please check desired shift(s):(Required)

Daylight

Afternoon/Evening

Overnight

Block Weekend

Indicate any shifts/days you are unable to work:(Required)

REFERENCES

Please list three professional references that can provide an employment related reference. Do not include personal/character references such as relatives or friends.

Name(Required)

Your Professional Relationship(Required)

Daytime Phone Number(Required)

Name(Required)

Your Professional Relationship(Required)

Daytime Phone Number(Required)

Summarize special job-related skills and qualifications acquired from employment or other professional trade, business or civic activities.

State any additional information you feel may be helpful to use in considering your application.

EMPLOYMENT HISTORY

Start with your present or most recent job. Include all jobs held regardless of length of service. Include any job-related military service assignments and volunteer activities. You may exclude organizations, which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Job:(Required)

Employer:

Address:

Phone Number:

Your Job Title:

Supervisor:

Dates Employed: (Month/Year) From:

Dates Employed: (Month/Year) To:

Describe Your Responsibilities:

Reason for Leaving:

To add other job experiences, click the “+” icon.

Please explain any gaps in your employment history. Give dates and reason for unemployment:

DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Are you capable of performing in a reasonable manner, with or without reasonable accommodation, the essential functions involved in the job for which you have applied?(Required)

Yes

No

APPLICANT’S STATEMENT

I certify that answers given herein are true and complete.
I certify that I have read and understand the “Arc Voluntary Invitation for Applicant Self-identification” (above) I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision, including contacting previous employers. I further authorize Arc, Fayette to obtain from a consumer reporting agency a port on my driving record, Act 33/34 clearances, and/or FBI check.
This application for employment shall be considered active for a period of time not to exceed six months. I understand that I will be considered for positions for which I may qualify but my application does not guarantee an interview will result.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

Signature(Required)