In-Home Personal
Care

Independent Living Services

Angels at Your Service

Accessible Home
Modifications

Service Dogs

Custom Wheelchair
Seating

Skills Instruction

Transition School

Employment Services

Adult Enrichment

Youth Sports,
Recreation and Arts

Government Programs

Application for Employment

United Disabilities Services is an Equal Employment Opportunity Employer. We comply with all applicable local, state and federal civil rights and equal employment laws and regulations.

Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non-job related physical or mental disability. In compliance with the Americans with Disabilities Act (ADA), Title I, if you are called for an interview, please advise us in advance if you will need any accommodations.

NOTE: this application will remain active for twelve (12) months. To be considered for employment beyond this period a new application must be submitted.
PERSONAL
Name
Address
Relatives or friends employed at UDS?
Would you consider working

Have you ever been employed by UDS?
Are you at least 18 yrs old?
Citizenship It is the employer's intention to hire only United States Citizens and aliens lawfully authorized to work in the United States. All newly-hired employees will be required to complete and sign the verification form designated by INS to certify that they are eligible for employment in the United States.
  or


Convictions
EDUCATION / SKILLS
High School
College
College
Other Skills
Professional licenses and/or certifications
If licensed, registered or certified
License/registration/certification #1
License/registration/certification #2
License/registration/certification #3
EDUCATION / SKILLS - EMPLOYMENT HISTORY Provide the following information for your past and current employers, assignments or volunteer activities, starting with the most recent (use additional sheets if necessary). Explain any gaps in employment in comments section below.
Employer #1
Dates Employed
Hourly rate/salary starting
Hourly rate/salary final
Employer #2
Dates Employed
Hourly rate/salary starting
Hourly rate/salary final
Employer #3
Dates Employed
Hourly rate/salary starting
Hourly rate/salary final
Employer #4
Dates Employed
Hourly rate/salary starting
Hourly rate/salary final
Did you serve in the U.S. Armed Services?
Have you volunteered your time or services?
REFERENCES List at least 3 references who are not relatives: who can verify work-related skills.
Reference #1
Reference #2
Reference #3
Reference #4
APPLICANT'S AGREEMENT AND RELEASE OF INFORMATION

CONDITIONS OF EMPLOYMENT (Read Carefully)

All offers of employment are contingent upon:
1. A satisfactory check of references, supporting transcripts and licensure or registry verification.
2. A satisfactory physical examination by our physician and drug/alcohol screen if required to meet program requirements.
3. A satisfactory criminal, child abuse or driving background check if required to meet program requirements.

APPLICANT'S ACKNOWLEDGEMENT
I certify that the information contained in this application is correct to the best of my knowledge, and understand that falsification of this information is grounds for refusal to hire or, if hired, dismissal. I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application, and release all such parties from all liability for any damages that may result from furnishing such information to you. I authorize you to request and receive such information. In consideration for my being considered for employment by your agency. I agree that in the event of employment to conform to the rules and regulations of the agency and acknowledge that these rules and regulations may be changed, interpreted, withdrawn, or added to by your agency at any time, at the agency's sole option, and without any prior notice to me. I further acknowledge that my employment may be terminated, and any offer of employment, or my acceptance of an employment offer, if such is to occur, may be withdrawn, with or without cause, and with or without prior notice, at any time, at the option of the agency or myself. I understand that no representative of the agency has any authority to enter into any agreement for employment for any specified period of time or to assure any other personnel action, either prior to commencement of employment or after I have become employed, or to assure any benefits or terms and conditions of employment, or make any agreement contrary to the foregoing. I understand that this application is not and is not intended to be a contract of employment.

I understand it is this agency's policy not to refuse to hire a qualified individual with a disability because of that person's need for a reasonable accommodation as required by the ADA. I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization.

I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.

I have completed the application.