Indian Creek Foundation

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Employment Application
  1. (*) Indicates required field
  2. Personal Information

  3. Full Name(*)
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  4. Address(*)
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  5. City(*)
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  6. State(*)
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  7. Zip(*)
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  8. Your Email(*)
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  9. Phone(*)
  10. SSN
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  11. Driver's License Number
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  12. State
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  13. Expiration Date
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  14. Referral Source(*)
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  15. If other, please list how you heard about Indian Creek Foundation.
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  16. If offered employment, can you submit verification of your legal right to work in the United States?(*)
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  17. Are your school/employment records listed under another name?(*)
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  18. Do you currently reside with or are you related to any Indian Creek Foundation employee or Board Member?(*)
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  19. Have you been convicted of a felony within the last seven (7) years?(*)
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  20. Have you previously applied at Indian Creek?(*)
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  21. May we contact your present employer now?(*)
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  22. Have you ever worked/volunteered in a community program serving people with mental health, intellectual or developmental disabilities?(*)
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  23. If yes, please list providers:
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  24. Employment Desired

  25. Position
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  26. When are you available to start work?
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  27. Please state any salary requirements:
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  28. Employment Desired(*)
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  29. Preferred Hours / Availability(*)

  30. Sunday
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  31. Monday
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  32. Tuesday
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  33. Wednesday
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  34. Thursday
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  35. Friday
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  36. Saturday
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  37. Previous Job 1

  38. Company Name
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  39. Type of Business
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  40. Company Address
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  41. Immediate Supervisor
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  42. Phone
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  43. Email
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  44. Reason for Leaving
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  45. Start Date (month/year)
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  46. End Date (month/year)
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  47. Starting Salary
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  48. Ending Salary
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  49. List job titles and explain duties:
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  50. Previous Job 2

  51. Company Name
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  52. Type of Business
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  53. Company Address
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  54. Immediate Supervisor
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  55. Phone
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  56. Email
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  57. Reason for Leaving
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  58. Start Date (month/year)
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  59. End Date (month/year)
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  60. Starting Salary
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  61. Ending Salary
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  62. List job titles and explain duties:
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  63. Previous Job 3

  64. Company Name
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  65. Type of Business
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  66. Company Address
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  67. Immediate Supervisor
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  68. Phone
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  69. Email
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  70. Reason for Leaving
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  71. Start Date (month/year)
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  72. End Date (month/year)
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  73. Starting Salary
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  74. Ending Salary
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  75. List job titles and explain duties:
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  76. Education

  77. Name of High School
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  78. Location
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  79. Major / Concentration
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  80. Did you graduate?
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  81. Type of Degree
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  82. Name of College / University
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  83. Location
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  84. Major / Concentration
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  85. Did you graduate?
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  86. Type of Degree
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  87. Graduate / Professional
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  88. Location
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  89. Major / Concentration
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  90. Did you graduate?
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  91. Type of Degree
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  92. Recent Related Training Experiences
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  93. Optional Information

  94. Ethnicity
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  95. Gender
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  96. References

  97. Professional Reference 1
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  98. Company
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  99. Address
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  100. Phone
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  101. Email
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  102. Relationship
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  103. Professional Reference 2
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  104. Company
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  105. Address
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  106. Phone
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  107. Email
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  108. Relationship
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  109. Professional Reference 3
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  110. Company
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  111. Address
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  112. Phone
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  113. Email
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  114. Relationship
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  115. Personal Reference
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  116. Title
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  117. Address
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  118. Phone
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  119. Email
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  120. Relationship
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  121. Upload Cover Letter
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  122. Upload Resume
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  123. In compliance with the Fair Credit Reporting Act, the Indian Creek Foundation hereby gives notice to all candidates applying for non-clerical / non-administrative positions that, as part of the application process, Indian Creek Foundation will conduct a Motor Vehicle Record Check (MVR) to verify the status of the candidate’s driver’s license and driving record. In addition, the Indian Creek Foundation reserves the right to conduct MVR’s on any employee at any point during his or her employment with Indian Creek Foundation. I have read and understand the above Disclosure to Applicants and by providing my name below this acts as an electronic signature. Information about HireRight’s privacy practices is available at www.hireright.com/privacy-policy.aspx.
  124. (*)
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  125. I understand that as a condition of employment, Indian Creek Foundation must perform reference checks to verify my employment history. I authorize Indian Creek Foundation to contact any reference listed above in order to obtain information concerning my past work performance, verification of dates of employment or salary, and my personal character. I hereby release any such employer or person from any and all liability.
  126. (*)
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  127. As part of the hiring process and in keeping compliant with funding sources, Indian Creek Foundation will verify all prospective and current employees through the OIG (Office of Inspector General) and GSA (Government Services Administration) Exclusion Checklists. The Exclusions Checklist will verify that you have never been debarred, excluded, or otherwise ineligible from participation in a Federal or State health care program or defaulted on a health education loan or scholarship.

    Being under investigation may not preclude you from employment. However, misrepresentation, falsification or material omission of information may result in failure to receive any offer or, if hired, in immediate dismissal from employment.

    I believe to the best of my knowledge that all information provided below is accurate, true and correct, and that I fully understand the terms of the Acknowledgment and Authorization.

  128. (*)
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  129. I certify that I have answered each of the questions on this Application for Employment honestly and without reservation. I authorize Indian Creek Foundation to contact any of my previous employers, except as noted, as well as any other reference source in order to verify the facts and information that I have furnished regarding my qualifications and character. I hereby release any such employer or person from any and all liability. As a condition of employment I consent to a medical examination and a controlled substance screening test, and understand that the findings of the medical examination and a positive result for alcohol, drugs and controlled substances will be considered in making the final employment decision. I further consent to a criminal background screening, child abuse check and/or driver's record, if required for the position for which I am applying. I understand that any misleading or incorrect statements that I may have made render this application void, and, if employed, may be the cause for my termination. I understand that, if employed, my employment will be at will and that I will not have a contract for employment nor a guarantee of employment. Indian Creek Foundation is an Equal Opportunity Employer, and shall treat all employees and all applicants for employment equally and fairly based upon job related qualifications in accordance with all applicable local, state and federal laws.
  130. Signature(*)
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    I have read and understand the above content, and providing my name in this box acts as my electronic signature.
  131. Date(*)
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