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Employment Opportunities | Pre-Application for Employment Form
Pre-Application for Employment Form   

Name:
Street Address:
City:
State:
Zip Code:
Home Phone:
E-mail:

When is the best time to contact you?

Are you applying for a position advertised on this website?  Yes No

What position are you applying for?

Are you 18 years or older?  Yes No

Do you have a valid driver's license?  Yes No

Please check if you are available to work:

Part Time:  Full Time:

Days:  Yes No

Evenings:  Yes No

Nights:  Yes No

Saturday:  Yes No

Sunday:  Yes No

Two most recent jobs (Start with most recent)         

1.  Employer:

 

Employer's Address:

 

Dates Worked:

 

If currently employed, may we contact you employer?

 

Contact Person:

 

If yes, Employer's Telephone #

 

2.  Employer:

 

Employer's Address:

 
Dates Worked:  
If currently employed, may we contact your employer?  
Contact Person:  
If yes, Employer's Telephone #  

Have you had any prior experience working with the developmentally disabled?  If yes, please explain.

 
Educational Information:  

Highest Education Completed:

 
Major:  
Message:

 

   
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Lexington Center Fulton County Chapter of NYSARC, Inc.
127 East State Street
Gloversville, New York  12078

Phone: (518) 773-7931 or 888-703-7318
Fax: (518) 775-1333
E-Mail: hr@lexcenter.org