Independence Village
   

Employment

EMPLOYMENT

What does it mean to be part of the Independence Hill Team?

As a member of our team, you may work harder than you ever imagined. You may often find yourself stretched to the limit, but you are unlikely to experience boredom or the feeling that your job is meaningless. And every day you can go home knowing you made a difference in someone’s life.

Here is what some of our employees have to say about working at Independence Hill:

I LOVE my job, everything about it! I actually want to get up and get to work.

I get a tremendous satisfaction from serving our residents. No two days are alike and there is no other job where you can love your customer like we do!

Here I am at work, doing my job and the residents end up making my day special. They are so appreciative!

Only upbeat and enthusiastic need apply!


Employment Application

Position applying for:
Name:
(Please use complete names rather than initial. Show any nicknames in parenthesis)


Have you ever used another name for work, school or business?
YesNo

If yes, please state name(s), dates, and circumstances:

Are you at least age 18?
YesNo

Email:
Address:
City:
State & Zip:
Phone:
Alt Phone:

Notify in case of emergency:

Name:
Relationship:
Address:
Wk phone:
Hm phone:

Do you engage in illegal use of drugs (for example: marijuana, cocaine, heroin, crack, speed, LSD, etc?
YesNo
Are you willing to be tested for the current illegal use of drugs?
YesNo

How were you referred to us?
Advertisement
Relative
Friend
Other
Walk-In

Have you ever (check all that apply):

been subjected to judicial punishment under the Uniform Code of Military Justice
been convicted
pled guilty
pled no contest
received court-ordered community supervision
received probation
been subjected to deferred adjudication
received pretrial diversion
received disposition for any crime (misdemeanors / felonies)

If yes, provide complete information on all criminal offense(s), date(s), location(s) (city and state), the nature of any alternative disposition program and the date(s) of completion. If you have received any alternative disposition for any criminal offense, you MUST disclose it and describe the program. Failure to disclose a criminal conviction, plea or alternative disposition will be considered falsification and will result in your ineligibility for employment.
Conviction of a crime is not an automatic bar to consideration for employment, except for specific crimes where employment is prohibited by state or federal laws. Factors such as age at time of conviction, length of time since offense, nature and seriousness of offense, and rehabilitation will be considered.


Education

Grade School Name:
Years completed:
Did you Graduate?
YesNo
Degree(s) received

High School Name:
Years completed:
Did you Graduate?
YesNo
Degree(s) received

College Name:
Years completed:
Did you Graduate?
YesNo
Degree(s) received

Trade, Business or vocational school name:

Years completed:

Did you Graduate?
YesNo
Degree(s) received

Employment History

Are you currently employed?
YesNo
May we contact your current employer at this time?
YesNo
If no, please explain:

Previous employer

Company Name:
Company Address:
Company Phone:
Worked From:
To:
Position and duties:
Salary (beginning) $
(ending) $
Supervisor’s name:
Reason for leaving:
Resigned with noticeQuit without noticeAsked to resignTerminatedLaid off
  Other, be specific:

Next Previous employer

Company Name:
Company Address:
Company Phone:
Worked From:
To:
Position and duties:
Salary (beginning) $
(ending) $
Supervisor’s name:
Reason for leaving:
Resigned with noticeQuit without noticeAsked to resignTerminatedLaid off
  Other, be specific:

Next Previous employer

Company Name:
Company Address:
Company Phone:
Worked From:
To:
Position and duties:
Salary (beginning) $
(ending) $
Supervisor’s name:
Reason for leaving:
Resigned with noticeQuit without noticeAsked to resignTerminatedLaid off
  Other, be specific:

Other employment history information:

Please explain all periods of unemployment between the above jobs

Have you ever been terminated from employment or asked to resign by any employer other than those listed above?

YesNo

If yes, please provide employer(s), location, date and explanation:


Other Qualifications

Please state any other information about your personal qualities, work skills, or other abilities which would assist us in considering you (including strengths, weaknesses, goals, etc.)

Do you speak any other languages beside English? (Please List)


Driving Record

Can you safely drive a vehicle?
YesNo
Do you have a valid, unexpired driver’s license?
YesNo
If yes, what is your current driver’s license number:
What is the expiration date:
What is the issuing state:


Has your driver’s license been denied, revoked, or suspended during the last five years:
YesNo
If yes, please explain:



List all traffic violations (other than parking tickets) for which you pled guilty, were convicted or pled no contest during the past three years.

Year
Nature of violation
Location (city and state)

References

Please do not include relatives or previous employers

Name
City and State
Phone
Occupation
Years Known

Resume

Please paste in your resume:
Or attach your resume here:



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