Employment Application

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity and gender expression, marital or veteran status, the presence of a non-job-related condition or any other legally protected status.

Employment Application
How did you hear about us? *
Please list the name of the employee who referred you: *
Hours you are available to work *
Times you are available to work *

GENERAL INFORMATION

Pronoun (Voluntary)
Address
Address
City
State/Province
Zip/Postal
Country
If you are under 18 years of age, can you provide required proof of eligibility to work?
Have you ever filed an application or worked for us before?
Are you currently employed?
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)
Are you currently on “lay-off” status and subject to recall?
Can you travel if a job requires it?

EMPLOYMENT EXPERIENCE

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations, which include race, religion, gender, national origin, handicap or other protected status.
Address
Address
City
State/Province
Zip/Postal
Country
May we contact this employer?
LIST ANY OTHER EXPERIENCES, SKILLS OR QUALIFICATIONS THAT YOU FEEL WOULD ESPECIALLY FIT YOU FOR WORK WITH OUR ORGANIZATION:

ARE YOU PHYSICALLY OR OTHERWISE UNABLE TO PERFORM THE DUTIES OF THE POSITION FOR WHICH YOU ARE APPLYING?

EDUCATION

High School/GED
Undergraduate College/University
Graduate/Professional
Other

FOREIGN LANGUAGES

Speak
Read
Write

PROFESSIONAL REFERENCES

PERSONAL REFERENCES

Not former employers or relatives.
Authorization

FOR STAFF WHO WILL BE DRIVING AGENCY VEHICLES:

Do you have a valid New York State Driver’s License?

STATEMENT OF PROFESSIONAL ETHICS AND CONDUCT

Have you ever been found by any professional association to which you have belonged to have violated its ethical code, or are you currently under investigation for an ethical violation by any other professional organization to which you belong? *
Have you ever had your registration, certificate or license to practice your profession suspended, revoked, restricted, or denied or has any other disciplinary action been taken against you by any federal or state regulatory body or foreign jurisdiction or are you presently under investigation by any regulatory body, to the best of your knowledge? *
Have you ever had your privileges to practice your profession in a hospital, HMO, etc., suspended or restricted or has any other disciplinary action been taken against you on grounds of unprofessional conduct, incompetence, negligence, or unsafe practices? *
Have you ever voluntarily given up privileges, registration, certificate or license to practice your profession, or agreed to restrict your practice in lieu of or to avoid formal action? *
Do you affirm that you are a member in good standing of your primary professional association (if appropriate)? *

FOR STAFF WHO WILL WORK WITH CHILDREN

*
*

DOCUMENTS

Applicant is required to attach resume submitting online application. (Cover Letter is optional)

Maximum file size: 52.43MB

Maximum file size: 52.43MB

APPLICANT’S STATEMENT

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

I authorize WJCS to obtain information about me from my previous or current employers. I authorize my previous and/or current employers to provide WJCS with such information as they may request. In order to encourage full and candid disclosure, I further agree to hold harmless my previous and current employers and WJCS from any and all claims arising from the disclosure or use of any information related to my past or current employment to the extent permitted by law.

This application for employment shall be considered active for a period of time not to exceed 1 (one) year from the date submitted. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

In the event of employment, I understand that false or misleading information given in my application or interview(s) is grounds for immediate dismissal. I understand, also, that I am required to abide by all rules and regulations of the employer.

WJCS is an equal opportunity community-based employer. WJCS does not discriminate in employment and no question on this application is used for the purpose of limiting or excluding any applicant's consideration for employment on a basis prohibited by local, state or federal law.

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

I authorize WJCS to obtain information about me from my previous or current employers. I authorize my previous and/or current employers to provide WJCS with such information as they may request. In order to encourage full and candid disclosure, I further agree to hold harmless my previous and current employers and WJCS from any and all claims arising from the disclosure or use of any information related to my past or current employment to the extent permitted by law.

This application for employment shall be considered active for a period of time not to exceed 1 (one) year from the date submitted. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

In the event of employment, I understand that false or misleading information given in my application or interview(s) is grounds for immediate dismissal. I understand, also, that I am required to abide by all rules and regulations of the employer.

WJCS is an equal opportunity community-based employer. WJCS does not discriminate in employment and no question on this application is used for the purpose of limiting or excluding any applicant's consideration for employment on a basis prohibited by local, state or federal law.

Acknowledgement