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Application for Employment

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Mission

The mission of AME Community Services, Inc. is to provide individualized services to our consumers, which allow them the opportunity to live as contributing citizens in their community. We believe that consumer and family participation is essential in enabling us to provide the best possible services. Consumer and family involvement in the planning of services is encouraged, solicited, and respected at all times.

If you have a resume or vita that describes the same information you may attach it to this application in lieu of repeating the information. You must read and sign this application however.

Please call AME Community Services directly with your SSN details after submitting your online form.

Required *

PERSONAL INFORMATION

First Name *

Middle Name

Last Name *

Mailing address

City *

State

ZIP Code

Phone numbers (Evening)

Phone numbers (Day Time)

In order to allow us to adequately check your employment and education history, please state any other name(s) under which you have been employed or attended school:

List all previous addresses for past 7 years From (month/year) to (month/year) Include city, state/province, country and zip code

Address1 – Street City, State, Zip

Address2 – Street City, State, Zip

Address3– Street City, State, Zip

For which position(s) are you applying? *

Salary Expected:

Date available to start work:

EDUCATION

Mark highest level completed * Some HS HS/GED Associate Bachelor Doctoral

Last high school (HS) or GED school. Give the school’s name, city, State, ZIP Code (if known), and year diploma or GED received.

Colleges and universities attended. Attach a copy of your transcript (if available)

Name of School *

City

State

Total Credits Earned

Major(s)

Degree

Year Received

Name

City

State

Total Credits Earned

Major(s)

Degree

Year Received

Name

City

State

Total Credits Earned

Major(s)

Degree

Year Received

WORK EXPERIENCE

Please start with your present or most recent position. List all employers for at least the last five years. Use a separate sheet if necessary. If attaching a resume, please complete those sections not covered by your resume.

Job title

From (MM/YY)

To (MM/YY)

Salary

Hours per week

Employer’s name and address

Supervisor’s name and phone number

Reason for leaving

May we contact this employer?

May we contact this Supervisor? Yes No

Describe your duties and accomplishments

Job title

From (MM/YY)

To (MM/YY)

Salary

Hours per week

Employer’s name and address

Supervisor’s name and phone number

Reason for leaving

May we contact this employer?

May we contact this Supervisor? Yes No

Describe your duties and accomplishments

Job title

From (MM/YY)

To (MM/YY)

Salary

Hours per week

Employer’s name and address

Supervisor’s name and phone number

Reason for leaving

May we contact this employer?

May we contact this Supervisor? Yes No

Describe your duties and accomplishments

Job title

From (MM/YY)

To (MM/YY)

Salary

Hours per week

Employer’s name and address

Supervisor’s name and phone number

Reason for leaving

May we contact this employer?

May we contact this Supervisor? Yes No

Describe your duties and accomplishments

OTHER QUALIFICATIONS

Details

GENERAL

Are you legally authorized to work in the U.S.?

Have you ever been in the military?

Are there any reasons you may not be able to perform the duties of the job as listed on the Position Description for which you are applying ?

Have you ever been convicted of a felony? *

Is there any reason that you are aware of that may cause you to fail a background study?

REFERENCES

Please list three references that we may contact. Do not list relatives, and please list complete names, addresses, and telephone numbers

Name

Relationship

Address

City

State

Zip Code

Email Address

Daytime Phone

Name

Relationship

Address

City

State

Zip Code

Email Address

Daytime Phone

Name

Relationship

Address

City

State

Zip Code

Email Address

Daytime Phone

APPLICANT CERTIFICATION

I certify that, to the best of my knowledge and belief, all of the information on and attached to this application is true, correct, complete and made in good faith. I understand that false or fraudulent information on or attached to this application, given during an interview, or at any other time during the hiring process constitutes sufficient grounds for disqualification from further consideration for hire or immediate discharge from employment and that AME Community Services, Inc. shall not be liable in any respect if my employment is so denied or terminated.

I understand all offers for employment are conditional upon satisfactory reference and background checks, production of documents necessary for AME Community Services, Inc. to verify identity and work authorization status.

In consideration of my employment, I will agree to abide by all practices and policies of AME Community Services, Inc...I understand my employment is at will and if an employment relationship is established, AME Community Services, Inc. or I may terminate the relationship at any time and for any reason.

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