EMPLOYMENT APPLICATION FORM

Note: You must complete each section of the application form entirely.  If you leave any section on the application blank, your application will not be considered for a position.  Please review your application before submission to ensure that each question has a clear response.  If you have questions, you may email them to the Human Resources department.

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PERSONAL DATA
The fields underlined are required and must be completed.
First Name:          Last Name:          Middle Initial:
Address:
City:             State:             Zip Code:
Telephone Number:             Best time to call?
Email:
Are you over the age of 18?     No    Yes   
Do you currently work for our organization?     No    Yes   
EMPLOYMENT INFORMATION
Position for which you are applying:
Please select a job category: Residential Services      Employment Services   
Select Work Schedule Desired: Full-Time Regular               Part-Time Regular                Relief/Per Diem  
                                                        Indicate # of hours:           Indicate # of hours:
Select Shift Preference: Day (Employment)   8am-4pm   9am-3pm       Evening    Night    Weekend   
Select Days Available: Monday   Tuesday   Wednesday   Thursday   Friday   Saturday   Sunday  
If hired when would you be able to begin work?
Do you have any commitments to another employer that affect your ability to work at WCI?
Information on Drivers License:       Do you have a drivers license? Yes     No                    Do you have a car? Yes     No    
      If yes, are you willing to use your vehicle to transport individuals to and from community activities?
     Yes     No    
      If no, are you willing to use public transportation? Yes     No    
REFERRAL SOURCE
How did you learn of WCI?
Name (and work site) of referral source:
Have you ever been employed by WCI before? Yes     No                    If yes, then please state:

Start and End Date(s):
Position:
Reason for leaving employment: