Application

Education / Skills
What high school did you attend?
Did you graduate from High School, or do you have a GED?
- Yes
- No
Where did you attend college?
What degrees do you hold?
Do you have any special skills that would apply to this job?
Have you/do you server in the U.S. Military, Naval Service, or National Guard? If so, what was your rank?

Former Employers
List below the last three employers you've had (if applicable) starting with the most recent.
Employer 1
Name of company/organization
Address
Phone Number
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY

Leave blank if you are currently employed
Supervisor
Position
Reason for Leaving
May we contact this employer?
What was your salary?
Employer 2
Name of company/organization
Address
Phone Number
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY

Leave blank if you are currently employed
Supervisor
Position
Reason for Leaving
May we contact this employer?
What was your salary?
Employer 3
Name of company/organization
Address
Phone Number
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY

Leave blank if you are currently employed
Supervisor
Position
Reason for Leaving
May we contact this employer?
What was your salary?

References
Give the names of 3 people not related to you and whom you have known for at least 1 year.
Reference 1
Name
Phone Number
Occupation
Years acquainted
Reference 2
Name
Phone Number
Occupation
Years acquainted
Reference 3
Name
Phone Number
Occupation
Years acquainted

Applicant Questionnaire
How did you find out about TECH, Inc.'s open position you're applying for?*
What do you know about TECH, Inc.?*
What made you apply for the position you're applying for?*
Do you have any paid or unpaid experience working with people with disabilities? If "yes" please explain.*
Tell me about your current job, if you're employed, or your last job, if you're not currently employed. What did you like most about the job? What did you find most challenging?*
How would you describe your relationship with your present or past supervisor?*
If I called your last supervisor, what would he/she say about you and your work performance?*
If you are currently working, what is your reason for making an employment change?
If you could create your own schedule, what would it be? Would you like full-time or part-time hours?*
List three strengths you feel are important when it comes to working with people with disabilities.*
List three weaknesses you may have related to the position you are interested in.*
How would you handle the following situation?*
The client you are working with is getting dressed for work. He realizes the belt he was going to wear is too big and the client becomes upset. The client proceeds to raise his/her voice and appears as if he/she might become physically aggressive.
Provide an example of how you could be flexible at work when resolving an issue with scheduling.*
Have you ever been asked to leave a job or position?*
- Yes
- No
TECH employees are required to attend 2 weeks of training (this is paid training with hours that may not be consistent with the hours of the position). Would you be able to attend all required training for TECH?*
- Yes
- No
I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected, and if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than it's CEO, and then only when in writing and signed by the CEO, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.*
- Yes
- No
Do you agree to these terms?

Step 1 of 5

Education / Skills

Former Employers

Employer 1

Employer 2

Employer 3

References

Reference 1

Reference 2

Reference 3

Applicant Questionnaire