Employment Application Form

First Name

Middle Initial

Last Name

Today's Date

Address

City

State

Zip

Home Phone Number

Cell Phone Number

Email Address

Position Applying For:

—Please choose an option—Awake Overnight Direct Support ProfessionalDirect Support AdvocateDirect Support ProfessionalDirect Support Professional – Behavioral TechnicianEmployment ConsultantHome Care ProfessionalOther (please specify below):

Days/Hours Available to Work

Monday Available Hours

Tuesday Available Hours

Wednesday Available Hours

Thursday Available Hours

Friday Available Hours

Saturday Available Hours

Sunday Available Hours

Type of Employment Desired:

Full-TimePart-TimeOn-CallTemporary

Where did you hear about Cascade Connections or who referred you to our organization?

Are you a U.S. Citizen?

YesNo

If not, are you eligible to lawfully work in the U.S.?

YesNo

Are you at least 18 years of age?

YesNo

Have you been employed by or applied to Cascade Connections before or any department of
Cascade Christian Services?

YesNo

If yes, when and where?

Have you ever been convicted of a crime or are there charges pending against you?

YesNo

If yes, please explain:

***State law requires that all employed to work with individuals with disabilities must undergo a background check. Persons who do not meet the eligibility criteria and/or are convicted of assault towards another person are not eligible for hire. Cascade Connections policy also states that all employees, upon being hired and at each review thereafter, must complete a driving abstract background check.***

Are you willing to complete a background check?

YesNo

Are you willing to complete a driving abstract background check?

YesNo

Education

High School
Name of High School

Location

College
Name of College

Location

Dates Attended

Degree

Major Field Study

Graduate School
Name of Graduate School

Location

Dates Attended

Degree

Major Field Study

Trade School
Name of Trade School

Location

Dates Attended

Degree

Major Field Study

Other School
Name of Other School

Location

Dates Attended

Degree

Major Field Study

Employment History - List your most recent job first

Company #1
Company Name

Address

Phone Number

Email Address

Position

Start Date

End Date

Major Job Duties & Responsibilities (Please be as detailed as possible)

Reason for Leaving

Supervisor’s Name and Title

Company #2
Company Name

Address

Phone Number

Email Address

Position

Start Date

End Date

Major Job Duties & Responsibilities (Please be as detailed as possible)

Reason for Leaving

Supervisor’s Name and Title

Company #3
Company Name

Address

Phone Number

Email Address

Position

Start Date

End Date

Major Job Duties & Responsibilities (Please be as detailed as possible)

Reason for Leaving

Supervisor’s Name and Title

May Cascade Connections contact each of these employers?
YesNo
If no, please explain:

Skills
Please summarize any relevant job-related skills or qualifications:

Please write a brief paragraph about why you want to work with people with disabilities:

References

Reference #1
Name

Relationship

Years Acquainted

Phone Number

Email Address

Reference #2
Name

Relationship

Years Acquainted

Phone Number

Email Address

Reference #3
Name

Relationship

Years Acquainted

Phone Number

Email Address

EEO Statement
We conform to all the laws, statutes, and regulations concerning equal employment opportunities and affirmative action. We strongly encourage women, minorities, individuals with disabilities and veterans to apply to all of our job openings. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, or national origin, age, disability status, Genetic Information & Testing, Family & Medical Leave, protected veteran status, or any other characteristic protected by law. We prohibit Retaliation against individuals who bring forth any complaint, orally or in writing, to the employer or the government, or against any individuals who assist or participate in the investigation of any complaint or otherwise oppose discrimination.

Authorization to Release Information
By signing this form, I, hereby recognize that I have applied for employment with Cascade Connections. I attest that everything entered in this form is truthful and honest. In completing this form and as part of the application for employment, I authorize that Cascade Connections may contact any company, institution, or individual it deems appropriate to verify the information contained in my employment application, resume, and/or verbal representations made during an interview. I authorize you to release to Cascade Connections any and all information and documentation it requests. A copy of this authorization may be accepted as an original.

Please leave this field empty.
Signature

Date

Attach Resume

Attach Cover Letter

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