Online Application - Enrichment Centers for Huron County

Incomplete information could disqualify you from further consideration. Please complete all fields.

Date

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Cell

Please list any special training or skills (CDL, languages, etc.)

Position Applying For:

Desired Salary:

Available Start Date:

Are you eligible to work in the United States?

Have you previously worked for Services for Aging?

Do you have any relatives working for Services for Aging?

Are you willing to undergo a background check, in accordance with local law/regulations?

Are there specific times you are unavailable to work?

Are you at least 18 years or older? (If no, you may be required to provide authorization to work)

Have you ever been terminated from employment or asked to resign by an employer?

Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?

Are you currently employed? If so, may we contact your current employer?

Employer Name & Phone Number

How did you hear about the position?

Education

Course of Studies

High School
Business or Trade School
College or University

High School Name

High School # of Years Completed

High School Degree Received

Did you graduate High School?

Business or Trade School Name

Business or Trade School # of Years Completed

Business or Trade School Degree Received

Did you graduate Business or Trade School?

College or University School Name

College # of Years Completed

College Degree Received

Did you graduate College?

Employment History

Include up to your last 7 years of employment. Begin with your current or most recent employer.

1. Employer Name

Dates of Employment (From - To)

Phone #

Job Title

May we contact this employer?

Supervisor Name & Title

Reason for Leaving:

Additional Previous Employers

2. Employer Name

Dates of Employment (From - To)

Phone #

Job Title

May we contact this employer?

Supervisor Name & Title:

Reason for Leaving:

3. Employer Name

Dates of Employment (From - To)

Phone #

Job Title

May we contact this employer?

Supervisor Name & Title:

Reason for Leaving:

4. Employer Name

Dates of Employment (From - To)

Phone #

Job Title

May we contact this employer?

Supervisor Name & Title:

Reason for Leaving:

References

List 3 persons not related to you, whom you have known at least three years.

1. Name

First

Last

Company

Phone

Years Aquainted

2. Name

First

Last

Company

Phone

Years Acquainted

3. Name

First

Last

Company

Phone

Years Acquainted

Optional: Upload Resume

Click or drag a file to this area to upload.

Upload your resume as a .pdf or .doc(x)file

Statement, Signature & Submit

Please read before signing

An Equal Opportunity Employer - All qualified applications will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. Services for Aging, Inc is an equal opportunity employer. Services for Aging, Inc does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex, sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Services for Aging, Inc to hire me. If I am hired, I understand that either Services for Aging, Inc or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Services for Aging, Inc has the authority to make any assurance to the contrary.

I attest with my signature below that I have given to Services for Aging, Inc true and complete information on this application. No requested information has been concealed. I authorize Services for Aging, Inc to contact the references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

Date

Signature

THIS APPLICATION IS VALID ONLY FOR 90 DAYS FROM THE DATE SIGNED/DATED ABOVE.

NORWALK

130 Shady Lane

M-Th 8:00 - 4:30

F 8:00 - 2:30

Sa -Su CLOSED

WILLARD

315 East Tiffin Street

M-Th 8:00 - 3:30

F 8:00 - 2:30

Sa -Su CLOSED

NORWALK

WILLARD

Education

Employment History

References

Optional: Upload Resume

Statement, Signature & Submit