Employment Application - The Arc of Ventura County

Contact Information
Name*
First Last
Have you ever used another name?
- Yes
- No
Names Used
Address
Street Address Address Line 2 City State ZIP Code
Phone
Email
Have you previously applied for employment with us?
- Yes
- No
If Yes: Month and Year
Location
Social Security Number (Optional)
Position applying for
Pay Expected
Are you available for full time work?
- Yes
- No
If not, what days/hours can you work?
Available for overtime?
- Yes
- No
When are you able to start?
Do you have relavites or friends who are board members, employed by or receive services from The Arc of Ventura County?
- Yes
- No
If Yes, Name & Relationship, one per line.
Referral - Mark all that apply
- Walk-In
- Employment Agency
- EDD/State Job Service
- Advertisement
- Employee Referral (Specify Below)
- School (Specify Below)
- Other company referral (Specify Below)
- Other (Specify Below)
Specify Referral
Education (High School)
Number years completed
Did you graduate?
- Yes
- No
Degree or Diploma
Employment History - Please give an accurate and complete employment record.
1st Employer - Company Name
Phone
Supervisor Name
Address
Street Address Address Line 2 City State ZIP Code
Date Started
Date Ended
Title/Duties
Reason for Leaving
May we contact this employer?
- Yes
- No
2nd Employer - Company Name
Address
Street Address Address Line 2 City State ZIP Code
Phone
Supervisor Name
Date Started
Date Ended
Title/Duties
Reason for Leaving
May we contact this employer?
- Yes
- No
3rd Employer - Company Name
Address
Street Address Address Line 2 City State ZIP Code
Phone
Supervisor Name
Date Started
Date Ended
Title/Duties
Reason for Leaving
May we contact this employer?
- Yes
- No
4th Employer - Company Name
Address
Street Address Address Line 2 City State ZIP Code
Phone
Supervisor Name
Date Started
Date Ended
Title/Duties
Reason for Leaving
May we contact this employer?
- Yes
- No
Special Skills & Qualifications
Summarize any training or special job-related skills and qualifications you may have that may be relevant to the position for which you are applying
Give name, address and telephone number of at least three references who are not related to you and are not previous employers
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Equal Employment Opportunity Employer
The Arc of Ventura County provides equal employment opportunities to all employees and qualified applicants for employment and prohibits discrimination on the basis of race, color, national origin or ancestry, age, religion, creed, physical or mental disability, medical condition, sex, sexual orientation, gender identity, genetics, marital status, pregnancy, citizenship, military status, or any other characteristic protected by federal, state or local law, except where a bona fide occupational qualification applies. This policy applies to recruitment, selection, placement, training, promotion, demotion, compensation and benefits, work schedules and job assignments, social and recreational programs, transfer, layoff and recall, termination, and all other aspects of employment.
Equal Employment Opportunity Employer - Initial to Acknowledge
Background and Reference Check
As part of its employment screening and selection procedures, The Arc of Ventura County requires background and reference checks for employees. Furnishing the information requested is mandatory. Failure to provide the information may delay or prevent completion of the application process. All applicants must complete a separate application. In determining an applicant's suitability for employment where the applicant has criminal convictions on his/her record, consideration will be given to the specific duties of the position and the nature of the offense(s). Misrepresentation, falsification, or material omission of information in this application may result in the failure to receive an offer, or if hired, dismissal from employment.
Discloure and Authorization to Obtain Information Form
Have you ever been convicted of a crime (felony or misdemeanor) OTHER THAN (1) a marijuana-related conviction that occurred more than two years ago; and (2) an offense for which you were referred to, and participated in, any pretrial or post-trial diversion program?
Convicted of a crime as stated above
- Yes
- No
If yes, please state the date of conviction, the county and state, and the nature of the offense.
Drug & Alcohol free workplace
The Arc of Ventura County maintains a Drug & Alcohol Free Workplace. All offers of employment are contingent upon a successful pre-employment drug screen. Refusing to consent to a pre-employment drug screen is considered a voluntary withdrawal from the employment process.
Drug Free Workplace Initial to Acknowledge
Pre-Employment Physical
All offers of employment with The Arc of Ventura County are contingent upon successful results of a medical physical which determines the ability to perform the essential duties of the position and includes a TB test.
Pre-Employment Physical Initial to Acknowledge
At-Will Policy
Employment with The Arc of Ventura County is "at will." This means that both the agency and the employee have the right to terminate the employment relationship at any time, with or without prior notice or cause, for any reason not expressly prohibited by law. Nothing in this document or any agency document should be understood as creating guaranteed or continued employment, a requirement that "cause" exist before termination, or any other guaranteed or continued benefits. The At-Will relationship can be changed only by an express individual written employment agreement signed by the Chief Executive Officer.
At-Will Policy Initial to Acknowledge
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Certification and Signature
I hereby certify that the information contained in this application form is true and correct to the best of my knowledge. I understand that any misrepresentation, falsification, or material omission of information on this application or on my resume may result in rejection of the application or termination of my employment, if hired. In connection with my suitability for employment, I authorize The Arc of Ventura County to check all personal and employment references.
Name
First Last
Date
When you click the submit button below your information for your application will be submitted. You will then be redirected to the Voluntary Information Form. We ask that you fill that out this form for govermental reporting purposes. The information is used for reporting to governmental agencies only. It is not used in determining eligibility for employment and is kept separate from the application form.
Phone

Contact Information

Employment History - Please give an accurate and complete employment record.

Special Skills & Qualifications

Give name, address and telephone number of at least three references who are not related to you and are not previous employers

Equal Employment Opportunity Employer

Background and Reference Check

Discloure and Authorization to Obtain Information Form

Drug & Alcohol free workplace

Pre-Employment Physical

At-Will Policy

Upload your resume here

Certification and Signature