[SDRC] SDRC Application for Employment

Date

Position Applying For

Applicant Information

Name (First Last)

Contact Phone Number

Briefly List Skills Relevant to Desired Position

Desired Office Location(s)

Main Office (San Diego/Kearny Mesa)

East County (Santee)

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

Are you 18 years of age or older?

Yes

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?

Our website, SDRC.ORG

Indeed

Zip Recruiter

Social Media

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

Upload a Cover Letter (optional)

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Upload a Resume (optional)

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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.

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

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.