Application for Employment

Position(s) applying for

Date Available for Work

Applicant Information

Name*

Preferred Phone*

Email Address*

Education / Training

High School

All applicants are required to have at a minimum (based on position) a high school diploma or GED from the US or an US Equivalency Evaluation report. It is the applicant's responsibility to provide the diploma, GED certificate or DHS approved US Equivalency Evaluation report. Applicants who completed College/University are required to provide the US diploma or an US Equivalency accreditation for postsecondary institutions.

Name/Location

Years Completed

College/University

Name/Location

Field of Study

Years Completed

Diploma/Degree and Date Received

Other

Name/Location

Field of Study

Years Completed

Diploma/Degree and Date Received

Working Considerations

Some positions require you to be at least 21 years of age. Are you at least 21 years of age?

Yes

Do you have a valid Illinois Driver’s License?

Yes

Have you previously been employed with Shore Community Services?

Yes

When were you employed with Shore Community Services? And with which department?

Certifications

CPR/First Aid

Yes

CPI or Safety Care

Yes

DSP Training

Yes

QIDP Training

Yes

Job History

Please complete in detail all requested information below or attach resume and include all information below. Begin with most recent job history.

List*

Employer Name-current or most recent

Job Title

Dates Employed

Address, City, State

Phone Number

Reason for Leaving

Supervisors Name, Title and Phone Number

Did you have supervisory Duties

Summarize Duties:

Additional Information (Optional)

Please read the following carefully and initial each paragraph.

Authorization*

I hereby authorize Shore Community Services, Inc. (SCS) to thoroughly investigate my references, work records, education, criminal record (including finger printing) and other matters related to my suitability for employment and, further, authorize my current and former employers to disclose to SCS any and all letters, reports, and other information pertaining to my employment with them, without giving me prior notice of such disclosure. In addition, I hereby release SCS, my current and former employers, and all other persons, corporations, partnerships, and association from any and all claims, demands, and liabilities arising out of or in any way related to such investigation or disclosure.

Understanding*

I understand that nothing contained in the application or conveyed to me during any interview that may be granted is intended to create an employment contract, implied or explicit, between me and SCS. I understand that the offer of employment can only be made by the Director or her/his designee. In addition, I understand and agree that if I am employed; my employment relationship with SCS is strictly voluntary and at our mutual will. I understand that if employed, my employment is for no definite period and may be terminated at anytime, with or without prior notice, with or without cause or reason, at the option of either myself or SCS and that no promises or representations contrary to the foregoing are binding on SCS unless made in writing and signed jointly by SCS’s Director and myself.

My signature below certifies that I have read and understand this complete page and agree to the terms and conditions outlined in this document. I further understand that I may need to complete additional applications if asked to do so.

Name*

Signature*

Date*

Phone

This field is for validation purposes and should be left unchanged.