TRC Employment Application

The Resource Center's Online Application for Employment

The following is an application for employment. Please answer all questions completely, an incomplete application will not be considered.

In compliance with federal and state equal opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or the presence of a non-job related medical condition or handicap.

Applications will be on file for one year, after which you must reapply to be considered for employment.

We do Pre-Employment Drug Screening for all positions.

Important Instructions: When filling out this application, do not press the <Enter> key. Use the <Tab> key to move from one response to the next. When you are finished completing the application, click the 'Submit Employment Application' button at the bottom of this page. Please note that fields marked with an asterisk (*) are required. If you fail to complete the required fields, we will not be able to process your application.

Date of Application (mm/dd/yy)

Work Location (choose ALL you would consider)

Jamestown

Dunkirk/Fredonia/Westfield

Position/s Applied For

Be specific:

Job Group

1. Officials and managers (Director, Administrator, Manager, Supervisor, etc)

2. Professional (Teacher, Accountant, Residence Manager, MSE, RN, all Clinicians, Coordinators, etc.)

3. Technicians (entry-level Bachelor or Associates degree, LPN, Industrial/Factory, Medical Asst., etc.)

4. Office & Clerical

5. Mechanic or related technical skill

6. Maintenance, Bus Driver (requires CDL license), Truck Driver, etc.

7. Service Workers (Cook, Aide-level positions: Direct Care, Residential, Preschool, Custodial, etc)

Details

*First Name

*Middle Initial

*Last Name
No special characters allowed: ex: ' * / :

*Address

*City

*State

*Zip

Home Phone #

Cell Phone #

e-mail address

Social Security #

If your interest in applying for employment with our organization was a result of any of the following referral sources, please indicate which ones:

Newspaper advertisement

State Job Service

College Placement Office

Radio Ad

Billboard

Internet Job Listing

Job Fair

Friend

Relative

Other )

If other, please specify

Are you eligible to work in the United States?

Yes No

Are you at least 18 years of age?

Yes No

Are you willing to work?

Full Time

Part Time

Substitute / On-Call

What shifts would you consider

Days

Evenings

Nights

What days would you consider?

All

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Are there any particular days of the week or hours of the day when you are not able to work?

Were you previously employed by us?

No Yes

If yes, in what position and when?

If you are expecting any particular rate of pay or have a minimum rate below which you will not accept a job, please specify

Record of Education

Name and Location of High School

Course of Study

Last Year Completed

Did you graduate?

Yes No

Degree, if any

Name of College

Course of Study

Last Year Completed

Did you graduate?

Yes No

Degree, if any

Name of College

Course of Study

Last Year Completed

Did you graduate?

Yes No

Degree, if any

Trade or Vocational

Course of Study

Last Year Completed

Did you graduate?

Yes No

Degree, if any

Post College

Course of Study

Last Year Completed

Did you graduate?

Yes No

Degree, if any

Employment History

List below all present and past employment beginning with the most recent

Employer Name

Employer Address

Phone

Position Title

Supervisors Name

Salary

Employed from

(month / year )

Employed to

(month / year )

Please specify your reason for leaving

What kind of work did you do?

Employer Name

Employer Address

Phone

Position Title

Supervisors Name

Salary

Employed from

(month / year )

Employed to

(month / year )

Please specify your reason for leaving

What kind of work did you do?

Employer Name

Employer Address

Phone

Position Title

Supervisors Name

Salary

Employed from

(month / year )

Employed to

(month / year )

Please specify your reason for leaving

What kind of work did you do?

Employer Name

Employer Address

Phone

Position Title

Supervisors Name

Salary

Employed from

(month / year )

Employed to

(month / year )

Please specify your reason for leaving

What kind of work did you do?

References

List three (3) work related references. References should be people we may contact who know you well and can verify your work history and habits. Do not list relatives.

Name

Address

City

State

Zip

Phone

What is your relationship with this person?

Name

Address

City

State

Zip

Phone

What is your relationship with this person?

Name

Address

City

State

Zip

Phone

What is your relationship with this person?

MISCELLANEOUS INFORMATION

List any community or professional organizations of which you are a member, include offices held. (Exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve, national guard or any other similarly protected status.)

List any licenses, certifications, experiences, practicums, skills or qualifications which you have that are related to the type of work for which you are applying

List any other information you would like us to consider.

New York State Law requires that applicants for certain jobs be screened for criminal convictions by a fingerprint check. If you are offered a job requiring the criminal background check, you will be informed of your rights and obligations under this process

You must give true and complete answers to the questions regarding misdemeanor or felony convictions and/or pending charges. Failure to do so may be considered falsification of application and grounds for dismissal or disqualification for job consideration. If you are uncertain as to the category of a conviction or pending charge, report it as uncertain level.

This criminal background check pertains to both convictions and pending arrests. Pursuant to New York State Law, no individual shall be denied employment by reason of this having been previously convicted of one or more criminal offenses unless the offense is directly related to the employment sought, or the employment of such individual would pose an unreasonable risk to the property or to the safety of others. Falsification of information on applications is immediate cause for dismissal.

Have you ever been convicted of a misdemeanor or a felony, in any jurisdiction?

No
Yes

If yes, complete the following

Misdemeanor
Felony
level uncertain

Jurisdiction

Date: (MM/DD/YYYY)

Description:

Are there any pending criminal charges against you in any jurisdiction?

No Yes

If yes, complete the following

Misdemeanor
Felony
level uncertain

Jurisdiction

Date: (MM/DD/YYYY)

Has there ever been an indicated or founded child abuse report filed against you with any government agency?

No Yes

If Yes, please state the details of the report. If no, please enter "N/A."

DRIVER'S LICENSE INFORMATION

Please note: Certain positions require a satisfactory driving record for employment.

Do you have a current valid driver's license?

Yes
Not licensed
Not Applicable (learners permit only)

Do you have a CDL (Commercial Driver's License)

Yes No

Issuing State

Driver's License Number

Expiration Date

Please provide a listing of any driving violations which you have had (other than parking tickets) during the past three (3) years. This is a required field – please indicate "None" if you have not had any violations.

If we require you to use a vehicle in connection with your work, do you have access to a vehicle you can use for that purpose

Yes No

Acknowledgement

By signing this application, I am representing that the facts set forth in the application are true and complete. I agree that any false or incomplete statement in this application shall be sufficient reason for rejection or dismissal, whenever discovered. The Resource Center is authorized to make an investigation of any information included in this application and to contact any of the schools, employers, government agencies or individuals noted for purposes of references or verification. I hereby release employers, schools or persons from all liability in responding to inquiries in connection with my application.
Type your initials here

I authorize The Resource Center to run a criminal background check on myself prior to or at anytime during my employment with the agency.
Type your initials here

I expressly authorize The Resource Center at any time hereafter, either while I am employed at The Resource Center or after conclusion of my employment at The Resource Center, to supply information to another institution or other party deemed by the agency to have an appropriate interest in the information. I hereby expressly release The Resource Center from any and all liability in connection with the release of any such information.
Type your initials here

I understand that the use of this application does not mean that there are any positions available and does not in any way obligate The Resource Center.
Type your initials here

I must, if position requires, possess and maintain a valid driver's license and be insurable by the agency's insurance carrier to driver agency owned vehicles. (A Motor Vehicle Report will be requested by an insurance agency representing The Resource Center.)
Type your initials here

I also recognize and agree that if I am offered and accept employment, I am not guaranteed any tenure of specific length of employment, and that my employment may be terminated at any time, with or without cause. I understand that no contract of employment exists between the agency and myself unless contained in a separate written and signed document which is expressly stated to be an employment contract. On occasion, the agency may establish and distribute policies relating to various aspects of my employment. I recognize that these are intended for my instruction, information and guidance and do not create any specific rights on my part or obligations on the part of the agency.
Type your initials here

I understand that The Resource Center has legitimate reason to be concerned with my standards of physical appearance and personal conduct since these matters can reflect upon the agency and my fellow employees. If accepted for employment, I agree to abide by all rules, regulations, policies, and instructions established by the agency. I recognize that these may change from time to time over the course of my employment.
Type your initials here

I also understand that The Resource Center is a drug free workplace and that a drug screening may be required with or without notice by the agency at any time.
Type your initials here

I intend to be legally bound by all authorizations, releases and agreements set forth in the application
Type your initials here

Today' s Date: (MM/DD/YYYY format)