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employment

Positions Currently Open:

Registered Nurse - Part-time. Approximately 10 hours per week.

Direct Support Professional - Full-time and part-time. Hours and days vary.

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including age, sex, color, race, creed, national origin, religious persuasion, marital status, political belief, or disability that does not prohibit performance of essential job functions.

Please complete the following form as completely as possible. If your contact information changes at any time, you will want to return to this form and submit new information. We may contact you to answer more questions or schedule an interview.

Employment application
*required info

Personal Information
*Name(Last, First, Middle):
*Email address:
*Phone:
Street Address:
City:
State:
Zip:
Social Security Number:

Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity (valid driver’s license, birth certificate, Green Card, etc.) within three days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.

Have you ever been convicted of a felony?



Educational History
Do you have a High School Diploma or GED? 



Have you attended a College or Technical School?



Referred to the agency by:

Employment Record
1. Company Name(Current or Most Recent Employer)::
Position Held:
Address:
Dates Employed:
 From:

Manager/Supervisor
Telephone:
Reason for leaving?
Can we contact?



 
2. Company Name:
Position Held:
Address:
Dates Employed:
 From:

Manager/Supervisor
Telephone:
Reason for leaving?
Can we contact?



 
3. Company Name:
Position Held:
Address:
Dates Employed:
 From:

Manager/Supervisor
Telephone:
Reason for leaving?
Can we contact?



 

Please Carefully Read The Following

Background Research Release

I hereby consent to permit Individual Support Systems, Inc. to contact anyone it deems appropriate to investigate or verify any information provided by me to discuss my suitability for employment, background, past performances, education or related matters. I expressly give my consent to any discussions regarding the foregoing and I voluntarily and knowingly waive all rights to bring an action for defamation, invasion or privacy, or similar causes of action, against anyone providing, or seeking such information.

I certify that I have and will provide information throughout the hiring process, including on this application for employment and in interviews with Individual Support Systems, Inc. that is true, correct, and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would unfavorably affect my application for employment. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for a position with Individual Support Systems, Inc. or my termination from employment if I am hired.

I have read and agree to the terms of the background research.
Comments:
Your application is not confirmed
until you receive confirmation.

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