Application

Applicant Information

SISO is an Affirmative Action/Equal Opportunity Employer/Drug-Free Workplace. If offered employment and accepted, you are required by law to show proof of eligibility to work in the United States. Please complete ALL aspects/sections of the application. All information given will be held in strict confidence. Incomplete applications will not be considered.

Full Name (First, Middle, Last) *

First

Middle

Last

Address Information

Address

Address Line 1

Address Line 2

City

State

Zip Code

Contact Information

Phone *

Email *

Date Available to Start *

Are you at least 18 years of age? *

Yes
No

Have you ever applied to this company before? *

Yes
No

Date

Have you ever worked for this company before? *

Yes
No

Date

Are you legally allowed to work in the United States? *

Yes
No

Scheduling Information

Are you seeking a permanent position? *

Yes
No

Type of Employment Desired *

Full Time

Available (Must select a minimum of 5 days for availability.) *

Shifts *

Any
Day (5:45am-2pm)
Evening (1:45pm-10pm)
Night (9:45pm-6am)

Are you willing and available to work overtime? *

Yes
No

Do you have friends or relatives employed at this company? *

Yes
No

Name

Do you have access to reliable transporation? *

Yes
No

Is there any reason you would not be able to be at work, on time, every day? *

Yes
No

If employed, what needs do you have for time off from work?

Physical Information

You are not required to disclose information about a physical or mental limitations that you believe will not interfere with your capability to perform the essential functions of the work for which you are applying. If you want us to consider special arrangements to accommodate a physical or mental impairment, you may identify that impairment in the space provided below and suggest the kind of accommodation that you believe would be appropriate.

Physical or mental limitations

Have you ever had any founded reports of child abuse or substantiated adult abuse? *

Yes
No

Educational Information

High School *

Did you graduate? *

Yes
No

Degree

Did you attend college?

Yes
No

College

Years Completed

1
2
3
4

Did you graduate?

Yes
No

Degree of Certificate

Major/Courses

Military Information

Are you a veteran? *

Yes
No

Duty/Specialized Training

Skills and Qualifications

How proficient are you at navigating a computer and using the internet on a scale of 1 to 5 (5 being the best)? *

How many words per minute do you type? *

Have you ever been or are currently CPR trained? *

Current
In the Past
Never

Have you ever been or are currently First Aid trained? *

Current
In the Past
Never

Other Skills

Other qualifications such as special skills, abilities, or honors that should be considered (including other languages or things related to this field you wish to bring to our attention such as past work with people with developmental disabilities and in emergency procedures)

References

References will be checked. Please provide only verifiable references. You must include 1 personal reference who is a member of your family. Additionally, please list 2 professional references who are not related to you (professor, supervisor, co-worker, etc). We do not collect social security numbers. If any of your references require a social security number to confirm information, please call us with that information.

Personal Reference *

First

Last

Phone *

Occupation *

How long have you know them? *

Professional Reference *

First

Last

Phone *

Company *

Work Relationship (co-worker, supervisor, etc.) *

2nd Professional Reference *

First

Last

Phone *

Company *

Work Relationship (co-worker, supervisor, etc.) *

Employment History

Please list the names of your present & previous employers in chronological order (with present or most recent employer listed first). You may also include any verifiable work performed on a volunteer basis, internships, or military service. Your failure to completely respond to each inquiry may disqualify you for consideration from employment.

Current/Most Recent Employer *

Address *

Address Line 1

City

State

Zip Code

Type of Business *

Phone *

Start Date *

Duties and responsibilities: *

Are you sill working with this employer? *

Yes
No

End Date

What will this employer say was the reason your employment ended?

How much notice did you give when resigning?

If None, please explain

Do you have another previous Employer? *

Yes
No

Next Previous Employer

Address

Address Line 1

City

State

Zip Code

Type of Business

Phone

Start Date

Duties and responsibilities:

Are you sill working with this employer?

Yes
No

End Date

What will this employer say was the reason your employment ended?

How much notice did you give when resigning?

If None, please explain

Do you have another previous Employer?

Yes
No

Next Previous Employer

Address

Address Line 1

City

State

Zip Code

Type of Business

Phone

Start Date

Duties and responsibilities:

Are you sill working with this employer?

Yes
No

End Date

What will this employer say was the reason your employment ended?

How much notice did you give when resigning?

If None, please explain

Have you ever been disciplined for attendance or lateness problems? *

Yes
No

Please Explain

How did you hear about us?

Previous Employee Name

Current Employee Name

Please Explain

Employment Disclosure

I understand that the company has a drug free work place. I understand that if a pre-employment drug test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug-free workplace, consistent with applicable federal, state, and local law. If employed, I understand that the taking of drug test is a condition of continual employment and I agree to undergo drug testing consistent with company policies and applicable federal, state, and local law.

I certify that all the information on this application, my resume, or any supporting documents I may present during any interview is and will be complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or if employed disciplinary action up to and including immediate dismissal. I authorize the company or its agents to confirm all statements contained in this application and/or resume as it relates to the position I am seeking and to the extent permitted by federal, state, or local law. I agree to complete any requisite authorization form for the background investigation.

I authorize and consent to, without reservation, any party or agency contacted by this employer to furnish the above mentioned information. I hereby release, discharge and hold harmless, to the extent permitted by federal, state, and local law, any party delivering information to the company or its duly authorized representative pursuant to this authorization from any liability, claims, charges, or causes of action which I may have as a result of the delivery or disclosure of the above requested information. I hereby release from liability the company and its representatives for seeking such information and all other persons corporations or organizations furnishing such information.

If hired by the company, I understand that I will be required to provide genuine documentation establishing my identity and eligibility to be legally employed in the United States by this company. I also understand that the company employs only individuals who are legally eligible to work in the United States.

This application will be considered active for a maximum of sixty (60) days, if you wish to be considered for employment after that time, you must reapply.

I certify that all of the information I have provided on this application is true, accurate, and complete.

This agency has my permission to contact references and previous employers as work references.

Applicants conditionally accepted for employment will be required to complete a criminal history/background check. Being hired by SISO is conditional pending an approved criminal history/background check.

If hired, your name or picture may appear in our company newsletter or on our company website. Information relating to achievements within the company, as well as employee birthdays (not birth year) may also be shared in our newsletter or on our website. If employees wish to refrain from either of these publications, please submit a written request to our administrative office.

AUTHORIZATION FOR RELEASE OF INFORMATION

As part of my employment with SISO, I hereby consent to and authorize the release of any and all information that may be considered in evaluation my qualifications for employment.

I therefore release all parties and persons connected with this request from all claims, liabilities, and/or damages arising out of providing such information.

By checking this box, I agree to the terms listed above *

I agree

Signature *