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Arc of Monroe Board

SERVICES

BUSINESS SERVICES

FOUNDATION

JIM MROCZEK CENTER

Smiling man with beard behind counter at Arc Floral.

Welcome! We are pleased that you are applying for a place on our team of caring professionals, working together to provide Group Home Living, Jobs, Day Skill Training, Work Training, and Family Services for adults with developmental disabilities in Monroe County

Fields with an * are required.

*First Name:

*Last Name:

*Address:

*City:

*State:

*Zip:

*Home Phone:

Other Phone:

E-mail:

*Hours Available

All Hours

	Mon	Tue	Wed	Thu	Fri	Sat	Sun
From
To

Work Availability:

Full TimePart TimeRelief

*Position:

*Start Date:

*Salary:

Education:

	Name/Address	Area of Study	Degree	Graduated
*High School/GED
College
Other

*Work History:

	Position/Employer	Dates Worked	Supervisor	Phone
1
Reason for leaving:
2
Reason for leaving:
3
Reason for leaving:
4
Reason for leaving:

*Special Skills:
Please describe your special skills, volunteer experience or life experience with people who have developmental disabilities, or other experience you have working with people...

Personal References:

	Name/Address	Occupation	Phone
1
2

*Other Information:
Please answer the following questions. Your responses may be relevant to certain jobs but won't necessarily keep you from being employed...

Do you have a valid drivers license?

YesNo

Are you legally eligible for employment in the United States?

YesNo

Have you worked for or applied for work at the Arc before?

YesNo

Have your ever been convicted of a crime?

YesNo

If you have, please tell us the nature of the conviction:

How did you hear about ARC:

Presently employed by The Arc

Employment World

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Where :

Self

Referred by Employee
Name :

Friend/Relative

Other

Resume Upload:

By submitting this form, I certify that the information I have provided is accurate and I authorize The Arc of Monroe County to confirm all information provided by me, including my work experience and education. I understand that the Arc is a drug/alcohol free work place and post-offer testing is part of the hiring process. In the event of employment and to ensure the safety and well being of all individuals served by the The Arc of Monroe County, I understand that my background will be checked. If I have provided false or misleading information during the application process this may be grounds for my immediate discharge.