Central Aroostook Association Online Employment Application

Central Aroostook Association Mission Statement
We provide people in our programs the necessary support to reach their highest level of personal development

P.O. Box 1245 • Presque Isle, Maine 04769 • (207) 764-0134 • Fax (207) 764-5543

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodations to the application and/or interview process should notify a representative of the Central Aroostook Association.

Position (s) applied for, please check all that apply:

Educational Technician

Direct Service Professional (DSP) Adult Programs

DSP Residential

DSP Home/Community Supports

Behavioral Health Professional Children Supports

Other (Please Describe Below

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Other PositionsInvalid Input

First Name(*)	M.I.	Last Name(*)
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E-mail(*)	Date(*)
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Current Street Address(*)	Apt. No.
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City(*)	State(*)	Zip Code(*)
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Home Phone(*)	Cell/Business/Other Phone:
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Are you a present or former employee of Central Aroostook Association? YesNo Invalid Input
Are you legally eligible to work or remain permanently in the U.S.? YesNo Invalid Input

Type of employment desired? Full-Time Part-Time Casual Part-Time Invalid Input		Date available for work(*) Invalid Input

Are you able to meet the attendance requirements for this position? YesNo Invalid Input
Have you ever been convicted of a crime? Answering YES to this question will not necessarily disqualify an applicant from employment. YesNo Invalid Input
If yes, please list date, nature of offense, location, status and penalty Invalid Input
Is there a criminal action currently pending against you? Answering YES to this question will not necessarily disqualify an applicant from employment. YesNo Invalid Input
If yes, please list date, nature of offense, location, status and penalty Invalid Input
Driver's license number and state.(*)
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If applying for Residential Services, Home/Community Supports or Children Supports Programs, Please Check All That Apply.

Are you willing to work holiday?				Are you willing to work Saturdays?
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Are you willing to work Sundays?				Are you willing to work overtime?
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Are you willing to work on call when needed?				Which shifts are you willing to work?
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Educational Background

Name & Location	Years Completed	Did you Graduate	Course of Study
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Employer One

From	To
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Company	Phone
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Job Title	Street Address
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Supervisor	Summarize the nature of work performed and job responsibilities:
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Reason For Leaving

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Employer Two

From	To
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Company	Phone
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Job Title	Street Address
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Supervisor	Summarize the nature of work performed and job responsibilities:
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Reason For Leaving
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Employer Three

From	To
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Company	Phone
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Job Title	Street Address
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Supervisor	Summarize the nature of work performed and job responsibilities:
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Reason For Leaving

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SKILLS & QUALIFICATIONS

Summarize any training, skills, licenses, and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.

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REFERENCES (2 professiona & 1 personal)

Full Name	Phone	Years Known
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DISCLAIMER AND SIGNATURE

PLEASE READ BEFORE SIGNING Applicant’s Certification and Release I understand that if I am employed, any misrepresentation or material omission made by me on this application or my resume may result in the cancellation of this application or immediate discharge from Central Aroostook Association’s service, whenever it is discovered. I authorize Central Aroostook Association to contact and obtain information from all references, employers, educational institutions, and any other person, and to otherwise verify the accuracy of the information contained in this application. I understand that any employment with Central Aroostook Association is on an at-will basis. I authorize Central Aroostook Association to verify all information set forth in my application and received during the application process by any and all means authorized or permitted by law, including but not limited to criminal checks, driver’s license checks, and any other background checks required by the State of Maine. I hereby release from liability Central Aroostook Association and its representatives for seeking, gathering and using such information and all other persons, corporations or organizations for furnishing such information. Central Aroostook Association does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state, or federal law. This application is current for only 30 days. At the conclusion of this time, if I have not heard from Central Aroostook Association and still wish to be considered for employment, I understand that it will be necessary to fill out another application. I understand that any employment with Central Aroostook Association is on an at-will basis. I further understand that if I am hired, I am free to resign at any time, with or without cause and without prior notice, and Central Aroostook Association reserves the same right to terminate my employment at any time, with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no representative of Central Aroostook Association, other than an authorized officer, has the authority to make any assurance to the contrary. I further understand that any such assurances must be made in writing and signed by an authorized officer. I understand it is Central Aroostook Association’s policy not to refuse to hire a qualified individual with a disability because of that person’s need for a reasonable accommodation as required by law. I represent and warrant that I have read and fully understand the foregoing.
Applicant Signature(*)	Date(*)
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Verification:(*)

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