Home About Us Jobs Our Approach Management Team Industry Involvement Partial Client List Services Roofing Evaluation Roofing Installation Infrared & Nuclear Moisture Surveys Products Project Profiles Contact Us Request a Quote Request Information or Evaluation Directions Online Application Step 1 of 2 50% Please read the following before completing our application: There is no guarantee of a job offer or a job interview in completing our application. Your application will be considered on a competitive basis with other candidates and interviews will be based on this comparison. Our application must be filled out completely in order to be considered for employment. If the information provided on our application cannot be satisfactorily verified by employment reference checks your application could be considered incomplete. Do you Accept the conditions above?*NoYes Personal InformationName* First Middle Last Present Address* Street Address City State / Province / Region ZIP / Postal Code Home Telephone Number*Cell Phone NumberEmail* Are you legally eligible for employment in the USA?*NoYesAre you 18 years of age or older?*NoYesDo you know anyone who works for SD Carruthers?NoYesIf Yes, indicate whom. How did you hear about SD Carruthers? Have you ever been employed by SD Carruthers?*NoYesIf Yes, indicate when and why you left. Have you ever been convicted of a misdemeanor or a felony in any jurisdiction or do you have any pending criminal charges against you?*NoYesIf Yes, indicate the date and nature of conviction or pending charge. Educational BackgroundHigh SchoolName & Address of SchoolDid you Graduate?NoYesCollegeName & Address of SchoolCourse of StudyDid you Graduate?NoYesDegree/Credits EarnedCollege/OtherName & Address of SchoolCourse of StudyDid you Graduate?NoYesDegree/Credits EarnedAwards or CertificatesAwards or CertificatesEmployment HistoryList below last three employers starting with most current or recent employer. Identify any prior or current experience as an employee, volunteer or certified provider with OPWDD, any other state agency, or any other provider of human services. Indicate an prior or current experience in direct care relevant to the position applying for.Job 1Employer: Address: Street Address City State / Province / Region ZIP / Postal Code Telephone:Immediate Supervisor: Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Title and Duties:Hours/Week: Reason for Leaving:Job 2Company: Address: Street Address City State / Province / Region ZIP / Postal Code Telephone:Immediate Supervisor: Start Date: MM slash DD slash YYYY End Date: MM slash DD slash YYYY Title and Duties:Hours/Week: Reason for Leaving:Job 3Company: Address: Street Address City State / Province / Region ZIP / Postal Code Telephone:Immediate Supervisor: Start Date: MM slash DD slash YYYY End Date: MM slash DD slash YYYY Title and DutiesHours/Week: Reason for Leaving:I give permission for SD Carruthers to contact my former employer(s).NoYesI give permission for SD Carruthers to contact my current employerNoYesAdditional Relevant Work History:Military ServicePlease complete this section if you served in the US Armed Forces. Branch Rank at Discharge Active Duty From: MM slash DD slash YYYY Active Duty To: MM slash DD slash YYYY Describe your duties and any special training:ReferencesPlease provide the names of three work related/professional references who we may contact.Professional Reference 1Name: Title: Telephone:Company: Address: Professional Reference 2Name: Title: Telephone:Company: Address: Professional Reference 3Name: Title: Telephone:Company: Address: Is additional information relative to a change of name, assumed name or nickname necessary to enable to check references for education or employment verification?* Yes No If yes, please explain:*I attest that the information that I have provided on my Application For Employment is true, correct, and complete to the best of my knowledge. I acknowledge that any false or misleading information or significant omission may disqualify me from further consideration for employment, or be the grounds for dismissal. I further understand that acceptance of an offer of employment does not create a contractual obligation upon SD Carruthers to continue to employ me in the future. If hired, I agree to abide by all of the company rules and regulations, and understand that my employment may be terminated at any time at the option of the agency or myself. I understand that an offer of employment is conditional based on background checks relative to the position I am being offered. I authorize SD Carruthers to investigate and obtain copies of records related to my employment history and education, and any additional information provided in connection with this application. I authorize all former employers and educational institutions to provide job-related information to SD Carruthers, and I release them and SD Carruthers from all liability or responsibility for supplying or requesting such information as part of an investigation. Signature*Date* MM slash DD slash YYYY DrivingFor Positions Requiring a Drivers License*, please answer the following:Have you had any suspension, revocation, DWI, DWAI Convictions or any occurrence involving harm to human beings or property while driving?**NoYesIf Yes, indicate the date and nature of conviction. Have you been convicted of any moving motor vehicle violations including, but not limited to alcohol or drug related offenses?**NoYesIf Yes, indicate the date and nature of the conviction. ** (NYS OMRDD Regulation Part 681)Exact Name as it appears on Drivers License: Driver License Number: State of Issuance: The information provided on this Addendum to the Application for Employment is true, correct and complete. I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future. SD Carruthers retains the right to dismiss an employee who has misrepresented or omitted any pertinent information on the Application or Addendum. Sincerely, Signature*Date* MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged.
