Employment Form | Independent Opportunities, Inc.

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APPLICATION FOR EMPLOYMENT

Step 1 of 7

14%

At which location would you like to apply?(Required)

Nashville

Columbia

Cookeville

Knoxville

Jamestown

Name(Required)

First Last

Preferred Phone(Required)

Alternate Phone

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Position applying for(Required)

H.T.S.

P.C.

Other

Other position:

How did you hear about this position at Independent Opportunities, Inc.?(Required)

Current employee

Internet website

Newspaper ad

Transitioning from another agency with consumer

Walk in

Word of mouth

Other

Name of employee

Name of website

Name of newspaper

Name of consumer

Other

Have you ever applied for a job with IOI before?(Required)

Yes

When

Have you ever been employed by IOI before?(Required)

Yes

When

Are you interested in full-time or part-time work?(Required)

Full Time

Part Time

What hours and days are you available to work?(Required)

What date are you available to start work?(Required)

May we contact your current employer?(Required)

Yes

Are you authorized to work in the United States?(Required)

Yes

Do you have a valid Driver’s License?(Required)

Yes

Issued in what state?

Have you ever been convicted of or pled guilty, nolo contendere or no contest to a criminal offense other than a minor traffic violation?(Required)

(A yes answer will not necessarily disqualify you from employment)

Yes

Please explain:

Are there any pending criminal charges against you for an offense other than a minor traffic violation?(Required)

(A yes answer will not necessarily disqualify you from employment)

Yes

Please explain:

Are you related to anyone employed by IOI?(Required)

Yes

Whom?

Relationship

Educational Background

High School

Name of school

Course of Study

# of Years Completed

Degree/Diploma

College

Name of college

Course of Study

# of Years Completed

Degree/Diploma

Post Graduate

Name of University

Course of Study

# of Years Completed

Degree/Diploma

Other Education

Course of Study

# of Years Completed

Degree/Diploma

EMPLOYMENT EXPERIENCE

List all employers for the past ten (10) years beginning with your most recent employment. Please explain gaps in employment history of more than 30 days.

Load as many past experience as nessesary.

Company Name	Address	Phone	Job Duties	Supervisor Name	Start Date	End Date	Reason for Leaving	Actions

There are no Entries.

Maximum number of entries reached.

Have you worked before with people who have developmental disabilities?(Required)

Yes

Please mark any of the below training in which you are currently certified:

CPR

Medication Administration

Fire Safety

Maltreatment

Safety at Home

Intro to DD

Universal Precautions

HIPAA

Individual Rights

Person Centered Planning

Positive Behavior Supports

Direct Support Professional

Title VI

Teaching People

Job Coach

CPI

PCM

Emergency Preparedness

Other Certifications

Independent Opportunities, Inc. primary purpose is to assist persons with developmental disabilities to reach their highest potential in everyday settings. Consequently, among the essential functions of an IOI job is the ability to bend at the waist, kneel, stoop and lift 50 pounds.(Required)

Can you perform these essential job functions either with or without reasonable accommodation?

Yes

By signing this application you acknowledge that you have read, understand and agree to the following(Required)

1. I hereby certify that the facts stated in this application are true and correct to the best of my knowledge. I agree that any false or inaccurate information in this application is sufficient reason for IOI to refuse to hire me and, if hired, to terminate my employment.

2. IOI is not obligated to provide me with employment and I am not obligated to accept employment.
Nothing in this employment application or anything communicated to me during an interview is intended to create an employment contract between IOI and me.

3. If I am employed by IOI, my employment will be at-will which means that either IOI or I may terminate the employment relationship at any time, for any lawful reason, with or without prior notice. IOI’s employment-at-will policy may not be modified verbally by any person and may not be modified by a written statement appearing in an IOI policy or document other than a formal written employment agreement signed by IOI’s Executive Director.

4. If I am hired, I will be required to provide documentation of my identity and my employment eligibility in the United States in accordance with the Immigration Reform and Control Act of 1986.

5. Illegal use, impairment, or sale of narcotic, or controlled substances (without a doctor’s prescription) or alcohol while on IOI property, at a remote worksite to which I am assigned to work, or while driving during the course of my employment is strictly prohibited. I agree to abide by the Alcohol and Drug Free workplace and testing policies of this company. Any violation of these standards may result in immediate termination of my employment.

6. I authorize IOI to conduct a criminal background check and any other background check required as a condition of my employment by statute, regulation or other law or by a governmental agency.

I agree to the terms listed above.

Human Verification

Signature(Required)