John Brooks Recovery Center Employment Application

PLEASE ANSWER ALL QUESTIONS!

Position(s) applying for::
  *

PERSONAL INFORMATION

Name:
  *
Address:
  *
City:
  *
State/Province:
  *
Zip/Postal Code:
  *
Email Adress:
  *
Daytime Telephone:

How did you hear about this position?

Select Source:
Name of Newspaper:
Agency Name:
JBRC Employee Name:
Other source:

General Questions

I will accept::
Full Time Employment
Part Time Employment
Weekend Hours
Evening Hours
Night Time Hours
  *
I was previously employed by JBRC or The Institute for Human Development:
Yes
No
  *
If so, When?:
What Position?:
Have you ever been convicted of a crime which has not been annulled or sealed by a court?:
Yes
No
  *
If yes, state the nature of the crime:

If hired, you are required to furnish proof that you are authorized to work in the United States. Without the proper documents, employment will not be extended beyond three (3) days as required by the Immigration Reform and Control Act.

John Brooks Recovery Center (JBRC) permits the employment of qualified relatives of employees as long as such employment does not create actual or perceived conflicts of interest. “Relative” is defined as a spouse, child, parent, sibling, grandparent, grandchild, aunt, uncle, first cousin or corresponding in-law or “step” relation. JBRC will exercise sound business judgment in the placement of related employees.

You are not required to disclose information about physical or mental limitations that you believe will not interfere with your capacity to do the job. Should you want JBRC, however, to consider special arrangements to accommodate a physical or mental impairment, you may identify that impairment in the space provided and suggest the kind of reasonable accommodation that you believe would be appropriate.

Disclosure:

EMPLOYMENT HISTORY


Please list present and past employment, beginning with most recent.
Present or most recent employer:
Employer Address:
Telephone:
Can we contact this employer?:
Yes
No
Job Title:
Hourly Rate / Salary:
Supervisor:
Dates of Employment:
Reason for Leaving:
======================================================================
Previous Employer:
Address of previous employer:
Telephone of previous employer:
Can we contact this previous employer?:
Yes
No
Job Title of previous employer:
Hourly Rate / Salary previous employer:
Supervisor previous employer:
Dates of Employment with this employer:
Reason for Leaving employment:
======================================================================
Previous employer (3):
Address employer (3):
Telephone employer (3):
Can we contact employer?:
Yes
No
Job Title employer (3):
Hourly Rate / Salary employer (3):
Supervisor employer (3):
Dates of Employment (3):
Reason for leaving employer (3):
======================================================================

EDUCATION AND TRAINING

Hign School:
Full Address:
Highest Grade Completed:
GED:
I did not graduate from High School but received a GED
College:
Highest Grade Completed:
Major:
Date you graduated:
Degree received:
Trade or Vocational School:
Address:
Training:
Certification and or completion date:
Please summarize special skills and qualifications acquired from employment or other experiences which would be pertinent to your application for employment. Enter this information in this box area.
Special Skills:
Please list professional license, registration or certification numbers and expiration dates below:
Title:
License Number:
Expiration Date:
Title:
License Number:
Expiration Date:
Title:
License Number:
Expiration Date:
JBRC is an equal opportunity employer and does not discriminate because of race, creed, color, ancestry, national origin, age, physical impairment, sex, sexual preference, marital status or obligation to U.S. Armed Forces If employed by JBRC, I agree to conform to the rules and regulations of JBRC If employed, I understand that my employment relationship is at-will and may be terminated by either me or JBRC at any time for any reason with or without notice. I understand that no supervisor, manager or director of JBRC has any authority to enter into any oral agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing. I release JBRC from responsibility to investigate in good faith and without malice my background and I understand
Agreement:
I certify and agree
  *
You may support your application for employment by uploading up to two documents. Use the upload feature below to attach your resume, etc... Files must be either text, MS Word (doc,xml) format files.
Delete:
Attach File
Send me a copy
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