Employment Application | AbilityWorks

Step 1 of 5 – Personal Information

20%

Personal

Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Phone(Required)

Home Phone

Emergency Contact(Required)

First Last

Emergency Contact Phone(Required)

Emergency Contact Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

General

Position applying for:(Required)

Date you can start:(Required)

MM slash DD slash YYYY

Valid Drivers License?(Required)

Yes

Do you want work that is:(Required)

Full Time

Part TIme

Permanent

Temporary

Do you want hours that are:(Required)

Days

Evenings

Nights

Weekdays

Weekends

Car Available?(Required)

Yes

Are you employed now?(Required)

Yes

Reason for job change:

Were you refered by a current AbilityWorks employee? If yes, please list their name.(Required)

Agency referral

Employee name:

Are you currently under investigation for abuse or neglect?(Required)

Yes

Have you been found for abuse or neglect?(Required)

Yes

Have you ever been convicted of a misdemeanor or a felony?(Required)

Yes

Auto accident in the past 3 years?(Required)

Yes

How many traffic tickets have you had in the past 3 years?

Do you have any physical limitations which would substantially interfere with your ability to perform the duties of the job for which you are applying?(Required)

Yes

Is yes, please explain:

Employment History

You must list all employment providing service to vulnerable adults

Employment

Name of Organization	Position Held	Actions
		Edit Delete
There are no History.

Maximum number of history reached.

Education

Highest High School Grade Completed(Required)

GED?(Required)

Yes

Educational Institutions(Required)

Name and Location

Did you graduate?

Degree

Graduation Year

Major Studies

Please list your high school and any higher educational institutions that you attended. To add more institutions, click the + button.

Other skills, training, qualifications, certifications, etc.

Check boxes if you have been trained in the following classes.

MAT

CPR

Foundations

First Aid

Briefly describe why you want this job.(Required)

References(Required)

Name & Occupation

Address

Telephone

Years Known

3 persons not related or former employers whom you have know at least 1 year. To add more references, click the + button.

Application Release(Required)

I agree to the application release

I certify that the facts set forth in my application are true and complete. I understand that if employed, false statements on this application shall be considered sufficient cause for dismissal. I authorize you to investigate statements contained herein and the references listed to give you any and all information concerning my previous employment, general character and personal characteristics. I hereby release all parties from liability for any damage that may result from furnishing same to you. I further authorize you to; Obtain copies of my driving record from the State issuing the license, obtain a copy of my criminal record from O.S.B.I, and check the Community Services Registry with the Oklahoma Department Of Human Services. I HAVE DISCLOSED ON THIS APPLICATION ALL PAST EMPLOYMENT PROVIDING SERVICE TO VULERNABLE ADULTS. I HAVE READ, SIGNED AND RECEIVED A COPY OF FORM DDS-39.

Signature(Required)

This field is for validation purposes and should be left unchanged.