PERSONAL INFORMATION:
First Name
Middle Name
Last Name
Street Number and Name
Apartment
Town
Zip code
Email Address
Phone Number
Contact me by:
Email
Phone
Highest Level of Education Achieved :
High School Diploma
Some College
Associates Degree
Bachelor’s Degree
Some Graduate
Graduate Degree
Name of Institute/College/School:
Specialization:
WORK EXPERIENCE:
MOST RECENT EMPLOYMENT:
Company Name
Company Address:
Company Phone:
Position Held:
Dates employed:
Reason for Leaving:
Supervisor’s Name:
Salary:
2ND MOST RECENT EMPLOYMENT:
Company Name:
Company Address:
Company Phone:
Position Held:
Dates employed:
Reason for Leaving:
Supervisor’s Name:
Salary:
Have you applied to The Arc in the past?
Yes
No If yes, when did you apply?
Do you know an employee of The Arc?
Yes
No If yes, name of employee
Do you have a valid NJ Driver’s License?
Yes
No
Have you ever been convicted of a crime?
Yes
No If yes, explain
Have you ever been civilly or criminally liable for the abuse of a developmentally disabled person receiving service?
Yes
No
If yes, explain.
Why are you interested in working at The Arc, Ocean County Chapter?
References:
Please provide the name, telephone number and relationship for three references.
Name of Reference
Phone Number
Relationship
Name of Reference
Phone Number
Relationship
Name of Reference
Phone Number
Relationship
Work Area Preference
Which department would you like to be considered?
Residential Services (group homes, supervised apartment, supportive living)
Vocational Services (day programs, supportive employment, adult drop off, after-school program)
Family Support Services (respite, real life choices, recreation)
Administration (finance, human resources)