Employment Application

An equal opportunity, affirmative action employer.

Step 1 of 4

Date*
MM slash DD slash YYYY
Personal Information
Name*
First Last
Address*
Street Address City State ZIP Code
Home Telephone*
Business Telephone
Email Address*
Confirm Email Address*
How did you learn about job openings at Aveyron?*
- Acquaintance
- Newspaper
Name of Acquaintance
First Last
Name of Newspaper
Have you ever applied for employment with us?*
- Yes
- No
If yes, when?
MM slash DD slash YYYY
Do you have any aliases?*
- Yes
- No
If yes, who?
First Last
Position Desired*
- Direct Support Professional
What type of hours are you looking for?*
- Full-time
- Part-time
- Full-time or Part-time
Specific Hours Requested*
Specific Shifts Unavailable to Work*
Pay Expected*
Are you able to lift minimum of 30 lbs?*
- Yes
- No
Are you over 21 years of age?*
- Yes
- No
Are you over 18 years of age?*
- Yes
- No
Are you legally eligible for employment in the U.S.?*
- Yes
- No
When will you be available to begin work?*
MM slash DD slash YYYY
Do you have a relative(s) that currently works for or receives services from Aveyron Homes? (Include in-laws, step-relatives, blood and foster/adopted relationships)
Current employee*
- Yes
- No
If yes, who and how are you related?
Current Service Recipient?*
- Yes
- No
If yes, who and how are you related?
Education Information
College or Technical School
Name & Location Course of Study Number of Years Graduate? Degree/Diploma
High School
Name & Location Course of Study Number of Years Graduate? Degree/Diploma
Describe any training or skills relevant to the position for which you are applying.
(Languages, machine operations, CPR, first aid, etc.)
What are your hobbies, interests, and memberships in professional or civic organizations?

Employment Information
Company Name
Telephone
Address
Street Address City State ZIP Code
Employed
(MM/YY) - (MM/YY)
This field is hidden when viewing the form
Hourly Pay
(Start and last)
Name of Supervisor
First Last
Job Title and Describe Your Work
Reason for leaving:
Company Name
Telephone
Address
Street Address City State ZIP Code
Employed
(MM/YY) - (MM/YY)
This field is hidden when viewing the form
Hourly Pay
(Start and last)
Name of Supervisor
First Last
Job Title and Describe Your Work
Reason for leaving:
Company Name
Telephone
Address
Street Address City State ZIP Code
Employed
(MM/YY) - (MM/YY)
This field is hidden when viewing the form
Hourly Pay
(Start and last)
Name of Supervisor
First Last
Job Title and Describe Your Work
Reason for leaving:
We may contact the employers listed above unless you indicate those you do not want us to contact.
DO NOT CONTACT
Employer Number(s) Reason

Personal References
(2 are required, 3 would be ideal)
Person to Contact*
Address*
Street Address City State ZIP Code
Phone*
Relationship*
Person to Contact*
Address*
Street Address City State ZIP Code
Phone*
Relationship*
Person to Contact
Address
Street Address City State ZIP Code
Phone
Relationship
Miltary
Did you serve in the U.S. Armed Forces?*
- Yes
- No
If yes, what branch?
In Case of Emergency, Please Notify:
Name*
First Last
Relationship*
Telephone*
Address*
Street Address City State ZIP Code

The information provided in this Application for Employment is true, correct, and complete. If employed, any misstatement or omission of fact on this application may result in my dismissal.

I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future.

If you decide to engage an investigative consumer reporting agency to report on my credit and personal history I authorize you to do so. If a report is obtained you must provide, at my request, the name of the agency so I may obtain from them the nature and substance of the information contained in the report.

Employment with Aveyron Homes, Inc. is at-will for each employee and is not governed by any oral or written contract. Either Aveyron Homes or the employee may terminate the employment, at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

I hereby indicate that I am receiving all necessary medical care, do not pose a risk to a child (or adult’s) health, and am physically able to care for foster children (and/or foster adults). Any limitations that I have are noted by me below (if nothing is written in, I am indicating that I have NO LIMITATIONS):

I hereby authorize Aveyron to conduct a pre-employment background study and I understand periodic studies may also occur, and will be necessary, throughout my employment.

I consent that my contact information will be shared among Aveyron Homes, Inc. and employees.
Date*
MM slash DD slash YYYY
Signature*
Data Consent*
- I consent to my submitted data being collected and stored for the purpose of evaluating and responding to my employment application
Comments
This field is for validation purposes and should be left unchanged.

Mission Statement

Employment Application

Step 1 of 4

Personal Information

Education Information

Employment Information

Personal References

Miltary

In Case of Emergency, Please Notify:

Additional Information

Partners & Memberships

Privacy Practices

Contact Us

Employer Number(s)	Reason