Section 1 of 1 in this document
Date
Position Applying For
*
Applicant Information
Name (First Last)
*
Contact Phone Number
*
Email
*
Current Address
Street Address
*
City
*
State
*
Zip
*
Briefly List Skills Relevant to Desired Position
*
Desired Office Location(s)
Main Office (San Diego/Kearny Mesa)
East County (La Mesa)
North County (San Marcos)
North Inland (Carmel Mountain)
South Bay (National City)
South Inland (Chula Vista/Eastlake)
Imperial Valley
If hired, can you provide proof of identity and authorization to work in the U.S.?
Yes
No
Are you 18 years of age or older?
Yes
No
List any language(s) spoken fluently other than English
List current employee of San Diego-Imperial Counties Developmental Services, Inc. who referred you.
Name
Relationship
Department
How did you hear about us?
Employee Referral
Indeed
Social Media
Vendor
Other
Please let us know the other place you heard of us.
Education Information
High School Education
Name of High School
City, State
Diploma Obtained
College/University Education
Name of College/University
City, State
Major/Degree Obtained
Graduate School Education
Name of Graduate School
City, State
Major/Degree Obtained
Other Education
Name of School
City, State
Major/Degree Obtained
Work Experience
DO NOT REFER TO RESUME
Begin with your most recent job.
List all jobs and/or periods of unemployment within the last ten years, including military service.
List any jobs held more than ten years ago which relate to the duties of the position for which you are applying.
Please fill out completely.
Employer #1 Basic Information
Name of Employer
Complete Address
Phone
Employer #1 Job Title, Employment Dates
Your Job Title
Start Date
End Date
Employer #1 Supervisor Details
Name of Supervisor
Job Title of Supervisor
Contact for Reference? (Yes/No)
Employer #1 Work Schedule
Full Time
Part Time
Employer #1 Brief Description of Duties
Employer #1 Reason for Leaving
Employer #2 Basic Information
Name of Employer
Complete Address
Phone
Employer #2 Job Title, Employment Dates
Your Job Title
Start Date
End Date
Employer #2 Supervisor Details
Name of Supervisor
Job Title of Supervisor
Contact for Reference? (Yes/No)
Employer #2 Work Schedule
Full Time
Part Time
Employer #2 Brief Description of Duties
Employer #2 Reason for Leaving
Employer #3 Basic Information
Name of Employer
Complete Address
Phone
Employer #3 Job Title, Employment Dates
Your Job Title
Start Date
End Date
Employer #3 Supervisor Details
Name of Supervisor
Job Title of Supervisor
Contact for Reference? (Yes/No)
Employer #3 Work Schedule
Full Time
Part Time
Employer #3 Brief Description of Duties
Employer #3 Reason for Leaving
Employer #4 Basic Information
Name of Employer
Complete Address
Phone
Employer #4 Job Title, Employment Dates
Your Job Title
Start Date
End Date
Employer #4 Supervisor Details
Name of Supervisor
Job Title of Supervisor
Contact for Reference? (Yes/No)
Employer #4 Work Schedule
Full Time
Part Time
Employer #4 Brief Description of Duties
Employer #4 Reason for Leaving
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The information provided in this Employment Application is true, correct and complete. If employed, any misstatement or omission of fact on the application may result in my immediate dismissal. I understand that this is considered "at-will" employment and may be terminated anytime, with or without cause, and with or without notice, at the option of either myself or the employer, and that acceptance of an offer of employment does not create a contractual obligation upon the employer to employ me in the future. I further certify that I currently have the legal right to work in the United States. I understand a physical examination and background investigation must be completed after employment is secured. Further, permission is hereby given to San Diego-Imperial Counties Developmental Services, Inc. to investigate previous employment, educational background and references. I release San Diego-Imperial Counties Developmental Services, Inc. and former employers from liability resulting from disclosure of information which shall be considered sufficient cause for dismissal or failure to employ applicant.
Application for Employment Terms of Agreement
I have read and agree with the statement above.
I agree to sign electronically.
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Email
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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.
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