Community Options, Inc.
Employment Application
Note: All Applicants must be at least 18 years of age.
calendar

 
Internet Access? Yes
Internet Acess? No

How did you learn about us?

calendar

Have you ever been employed with us?

Are you currently employed?

May we contact your present employer?

Do you have any friends, relatives or acquaintances working for Community Options?

If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States?

Please read the job description for which you are applying. Are you able to perform the essential funtions of the job, with/without reasonable accommodation?

Our Insurance company dictates that staff under the age of 21 must have no more than one moving violation or one accident in the past three years. If you are under 21 years old, can you meet this requirement?

Have you ever pled guilty, pled no contest, not guilty or been convicted of a crime? If yes, please explain (providing information regarding the crime and date(s)).

EDUCATION

High School Graduate?

List vocational schools, colleges and universities attended.
 Name & LocationArea of StudyDegree Obtained
1
2
3
List professional, trade, business or civic activities and offices held. Do not include information that indicates race, religion, gender, national origin, disability or other protected status.
 -
1
2
3

EMPLOYMENT

0/255 characters
Dates of Employment: 
 FromToRate of Pay
-
0/255 characters
Dates of Employment: 
 FromToRate of Pay
-
0/255 characters
Dates of Employment: 
 FromToRate of Pay
-
0/200 characters

REFERENCES

 NameAddressPhoneOccupation
1
2
3

APPLICANT'S STATEMENT

EMPLOYMENT DATA RECORD

Employees are treated during employment without regard to Race, Color, Religion, Sex, National Origin, Age, Marital or Veteran Status, Medical Conditions or Disabilities, or any other legally protected status. If you need interpretation services, such as a sign language or some language other than English, you should request that the agency provide this service. If you believe you have been denied benefits, services or employment because of race, color, national origin or disability you may contact the Personnel Department at Community Options, Inc. As an employer with an Affirmative Action Program, we comply with government regulations, including Affirmation Action responsibilities where they apply.

The purpose for this Data Record is to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of this data record is optional. If you choose to volunteer the requested information please note that all data records are kept in a confidential file and are not a part of your application for employment or personnel file.

PLEASE NOTE

YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.

Gender?

Race or Ethnicity Identity

Veteran Status

DISCLOSURE AND AUTHORIZATION FORM TO OBTAIN CONSUMER REPORTS FOR EMPLOYMENT PURPOSES Please Read Carefully Before Signing the Authorization DISCLOSURE

In considering you for employment and, if you are employed, in considering you for subsequent promotion, assignment, reassignment, retention, or discipline, Community Options, Inc. (“the Company”) may request and rely upon one or more consumer reports or investigative consumer reports about you that we obtain from a consumer reporting agency, such as IntelliCorp Records, Inc.

 

IntelliCorp Records, Inc. can be contacted by mail at 3000 Auburn Dr, Suite 410; Beachwood, OH 44122; or phone: 1-888-946-8355; or website: www.intellicorp.net.

 

For explanation purposes:

  • a “consumer report” is a written, oral or other communication of any information by a consumer reporting agency bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in making an employment-related decision about you. Such information may include, for example, credit information, criminal history reports, or driving records; and

 

  • an “investigative consumer report” is a consumer report in which information on your character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with your prior employers, neighbors, friends, or associates, or with others who may have knowledge concerning any such items of information. In the event an investigative consumer report is requested about you, you are entitled to additional disclosures regarding the nature and scope of the investigation requested, as well as a written summary of your rights under the Fair Credit Reporting Act (“FCRA”).

 

Under the FCRA, before the Company can obtain a consumer report or investigative consumer report about you for employment purposes, we must have your written authorization.  Before we take adverse action on the basis, in whole or in part, of information in that report, you will be provided a copy of that report, the name, address, and telephone number of the consumer reporting agency, and a summary of your rights under the FCRA.

AUTHORIZATION

 I have read and understand the foregoing Disclosure, and authorize Community Options, Inc. to obtain and rely upon consumer reports or investigative consumer reports in considering me for employment and, if I am employed, in considering me for subsequent promotion, assignment, reassignment, retention, or discipline. By my signature below, I authorize the Company to obtain any such reports and to share the information received with any person involved in the employment decision about me.


authorize you to contact my current employer for Employment and Reference Verifications   

(This will authorize immediate inquiries to the Human Resources Department and to any listed supervisors or references in the Employment/Reference Section of your application.)

 

I also agree that this Disclosure and Authorization in original, faxed, photocopied, or electronic (including electronically signed) form will be valid for any consumer reports or investigative consumer reports that may be requested about me by or on behalf of the Company

Personal Data

Addresses for the Past Seven Years:

 You can click here to return to our web site. Thank you. www.communityoptionsinc.org