Apply Online : Careers : The Arc of Middlesex County

Apply Online

Position(s) applying for

Please state location and full-time/part-time

First Name

Last Name

Street Address

City, State, ZIP

Social Security Number

Phone Number

Email Address

Referral Source (How did you hear about us?)

If you are under 18 and it is required, can you furnish a work permit?

If no, please explain:

Have you ever been employed here before?

If yes, give dates and positions:

Is this application a request for reemployment following an extended military leave of absence from this company?

Are you legally eligible for employment in this country?

Date Available For Work:

Month

Day

Year

Are you able to perform the "essential functions" of the job for which you are applying (with or without reasonable accomodation?) (NOTE: This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law).

Yes
No
Need more information about the job's "essential functions" to respond

Driver's license number required if driving may be required in the job for which you are applying: (NOTE: Please include state).

Answering "yes" to either part of the following question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.

Have you ever pleaded "guilty" or "no contest" to, or been convicted of, a crime?

Have you ever been adjudged of abusing a developmentally disabled individual?

If yes, please provide date(s) and details:

Employment History

Starting with your most recent employer, provide the following information.

Employer

Street Address, City, State

Telephone number:

Date began employment:

Month

Day

Year

Date ended employment:

Month

Day

Year

Starting job title/final job title

Immediate supervisor and title (for most recent position held)

May we contact for reference?

Yes
No
Later

Email or phone number for reference:

Why did you leave?

Summarize the type of work performed and job responsibilities:

Employer

Street Address, City, State

Telephone number:

Date began employment:

Month

Day

Year

Date ended employment:

Month

Day

Year

Starting job title/final job title

Immediate supervisor and title (for most recent position held)

May we contact for reference?

Yes
No
Later

Email or phone number for reference:

Why did you leave?

t9x25apr1889

Summarize the type of work performed and job responsibilities:

Skills and Qualifications

Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying:

Computer Skills: Check the appropriate boxes.

Word Processing
Spreadsheet
Presentation
Email
Internet

Educational Background

Starting with your most recent school attended, provide the following information.

School (Include City and State)

Years Completed

Degree Completed

Diploma
GED
Bachelor's
Master's
Certification
Other

GPA

Major/Minor

School (Include City and State)

Years Completed

Degree Completed

Diploma
GED
Bachelor's
Master's
Certification
Other

GPA

Major/Minor

References

List names and telephone numbers of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.

Reference 1

Name:

Title:

Relationship to you:

Telephone number:

Email:

Number of years known:

Reference 2

Name:

Title:

Relationship to you:

Telephone number:

Email:

Number of years known:

Reference 3

Name:

Title:

Relationship to you:

Telephone number:

Email:

Number of years known:

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.
I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.
I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.
I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.
If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.
I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.
This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, genetic information, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, genetic information, citizenship, age, disability, or any other protected status. The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.

I understand that any information provided by me is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICATION STATEMENT.

I certify that I have read, fully understand and accept all terms of the foregoing Application Statement.

Signature of applicant

Please type your full name in the box below. This serves as your electronic signature.

Date

Month

Day

Year