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Application for Case Manager
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daily
weekly
not often
Current Employer
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May we contact?
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Job Position
Position Applied for
-- Choose a position --
Case Manager
Information Technology
Daily Living Skills Services
Other Job Position
Full-Time or Part-Time
-- Choose Full-Time or Part-Time --
Full-Time
Part-Time
Date available to start work
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Background Information
Have you ever filed an application with us before?
Yes
No
Our direct service positions require travel with and without clients. Are you willing to travel for this position?
Yes
No
Do you have a valid driver’s license?
Yes
No
Have you been convicted of a felony in the last 10 years? If yes, please explain.
A conviction will not necessarily disqualify an applicant from employment
.
Yes
No
Are you prevented from lawfully becoming employed in this country because of visa or immigration status?
Proof of citizenship and/or immigration status will be required upon employment
.
Yes
No
Have you been convicted of OUI (operating a vehicle while under the influence of alcohol or drugs) within the past three years?
Yes
No
Are you able to perform the essential functions the job you are applying for with or without accomodations? (
If yes please list accomodations as needed
)
Yes
No
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