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Employment Application

If you would rather print out the form and mail it in, click here to download the PDF version.

ARBOR Associates, Inc., is an Equal Opportunity/Affirmative Action Employer. All applicants for employment are considered without regard to race, gender, religion, national origin, age, sexual orientation, disability or veteran status.

Please select the office to which you want to send this form:

Name:
(first, middle, last)
Street address:
City, state, zip:    
Phone:
Email:
Social security #:

How were you referred to ARBOR Associates?

Advertisement   Internet
Friend  Relative   Person's name:
Other:

Work preference:

Full-time   Part-time   Temporary
Days available for work:

Monday   Tuesday   Wednesday   Thursday  
Friday   Saturday   Sunday  

HOURS AVAILABLE: Apart from absence for religious practice, what shifts are you available for work. NOTE: ARBOR services various programs /agencies seven days a week/24 hours per day. Please check which shifts you are available for work. Shift times may vary based on programs needs. 7:00 am – 5:00 pm
1:00 pm – 12:00 am
10:00 pm – 9:00 am

EDUCATION

Type of school
Name & location of school
Course of study
No. of years completed
Did you graduate?
Digree or diploma
Graduate
College
Business / trade
High school

Do you now or have you ever worked for a staffing agency?   Yes   No

If yes, please list below the name of the agency(ies), and the dates worked:

1. Agency Name:   Date(s) Worked:
2. Agency Name:   Date(s) Worked:

Will you travel via public transportation?   Yes   No

Will you travel via personal transportation?   Yes   No

Professional certification/training

Name of training Date of training Date certificate expires
1.
2.
3.

REFERENCE AUTHORIZATION AND RELEASE

Please list at least FOUR individuals who can provide ARBOR with feedback regarding your abilities. Two of these references MUST be current or former Supervisors/Co-Workers.
1. Organization name:
Street address:
City, state, zip:    
Telephone:
Reference name:
Relationship:

Supervisor   Co-worker   Professor
Personal   Other:

2. Organization name:  
Street address:
City, state, zip:    
Telephone:
Reference name:
Relationship:

Supervisor   Co-worker   Professor
Personal   Other:

3. Organization name:  
Street address:
City, state, zip:    
Telephone:
Reference name:
Relationship:

Supervisor   Co-worker   Professor
Personal   Other:

4. Organization name:  
Street address:
City, state, zip:    
Telephone:
Reference name:
Relationship:

Supervisor   Co-worker   Professor
Personal   Other:

I hereby authorize ARBOR Associates, Inc., to contact my current and or previous employers and those individuals listed above for the purpose of verifying my current and or previous employment for the purpose of obtaining employment references.

EMPLOYMENT HISTORY

Please list at least FOUR individuals who can provide ARBOR with feedback regarding your abilities. Two of these references MUST be current or former Supervisors/Co-Workers.
1. Organization name:  
Street address:
City, state, zip:    
Telephone:
Name of supervisor:
Employed: From (mo/year): /   to (mo/yr): /
Pay rate/salary:
Job title and duties:
If no longer employed here, reason for leaving:

2. Organization name:  
Street address:
City, state, zip:    
Telephone:
Name of supervisor:
Employed: From (mo/year): /   to (mo/yr): /
Pay rate/salary:
Job title and duties:
If no longer employed here, reason for leaving:

3. Organization name:  
Street address:
City, state, zip:    
Telephone:
Name of supervisor:
Employed: From (mo/year): /   to (mo/yr): /
Pay rate/salary:
Job title and duties:
If no longer employed here, reason for leaving:

An applicant for employment with a sealed record on file with the commissioner of Probation may answer “No Record” with respect to inquiry herein relative to prior arrest, criminal court appearances or convictions. Any applicant for employment may answer “No Record” with respect to any inquiry relative to prior arrests, court appearances and adjudication’s in all cases of delinquency or as a child in need of DMR and EOHHS requires a CORI check on all new employees.
1. Have you ever been convicted of a felony?
Yes   No   If yes, give details below:
(In answering the following questions, do not include a first conviction for drunkenness, simple assault, speeding, minor traffic violations, affray or disturbance of the peace.)
2. Have you been convicted of a misdemeanor within the last 5 years?
Yes   No   If yes, give details below:
3. If you have been convicted of either a misdemeanor or felony within the last 5 years, have you been convicted of a misdemeanor 5 or more years ago?
Yes   No
I hereby affirm that all of the information I have provided on this application is true and complete, and I understand that any false information or omission of fact, may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. I authorize the investigation of any information provided in this application that is deemed necessary by ARBOR in arriving at an employment decision. I understand that this application is not construed to be an employment contract and that, if hired, my employment is for no definite period and may be terminated at any time. I agree to abide by all of ARBOR Associates, Inc., policies and procedures.