Employment: Application Form

In this section: Job Postings | Application | Living and Working in Central Virginia and the Shenandoah Valley

EQUAL EMPLOYMENT OPPORTUNITY
All employees of SPECTRUM Therapy are selected on the basis of their ability to fulfill established specifications for the job. General criteria include education, experience, interpersonal skills, physical ability, and willingness and compatibility to work in the specific environment. No person is discriminated against in regard to race, color, creed, religion, gender, age, citizenship, national origin, marital status, sexual orientation, disability, or any other status or characteristic protected under applicable local, state or federal laws.

Position(s) Applied for:
How did you learn about us?
Full Name:
Address:
City:
State, Zip:	,
Phone:
Email:
Social Security:
Are you currently employed?	Yes No
May we contact your employer?	Yes No
On what date would you be available for work?
What are you looking for?	Full-time and/or Part-time
EDUCATION AND TRAINING List your Formal Education Training, i.e. high school, college.
EMPLOYMENT RECORD Include all employment for the last five years.
Employer #1 (most recent):
Address:
City:
State, Zip	,
Dates Employed:	to
Supervisor:
Phone
Wage:
Reasons for Leaving:
May we contact this employer?	Yes No
Employer #2:
Address:
City:
State, Zip	,
Dates Employed:	to
Supervisor:
Phone
Wage:
Reasons for Leaving:
May we contact this employer?	Yes No
Employer #3:
Address:
City:
State, Zip	,
Dates Employed:	to
Supervisor:
Phone
Wage:
Reasons for Leaving:
May we contact this employer?	Yes No
OTHER INFORMATION
Is there anything that would prevent you from lawfully becoming employed in this country because of Visa or Immigration Status?
Have you been convicted of a felony within the last 7 years?	Yes No
If yes, please explain?
REFERENCES Please provide at least 3 references: Include name, address, occupation, years known, and telephone number. Reference #1: Reference #2: Reference #3: