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Employment Application

Valley Cares, Inc. is an equal opportunity employer and affords equal opportunity to all applicants for all positions without regard to race, color, religion, gender, national origin, age, disability, veteran status or any other status protected under local, state or federal laws.

You may fill out and submit this online application OR Print the application and mail it to: Valley Cares, PO Box 341, Townshend, VT 05353.

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How did you hear about us?
Advertisement Current Employee (*) Other (*)
Are you legally eligible to work in the United States? (Proof of eligibility will be required upon offer of employment) *

Are you over the age of 18 years? (If no, you may be required to provide authorization.) *

Can you with or without reasonable accommodation perform the essential functions of this job? (If you have any questions about the functions of the job, please ask the interviewer before answering this question.) *

Have you ever applied to Valley Cares, Inc. before? * (*)
Have you ever worked for Valley Cares, Inc. before? * (*)
Have you ever been convicted of a felony? (A conviction will not necessarily disqualify you.) *

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Do you have a valid driver's license? (For driving positions only.) *
Have you been convicted of any moving violations in the past five years? *

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Is anyone related to you employed by Valley Cares, Inc.? *

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What salary or rate of pay do you expect to receive if employed? per hour. *
Have you ever been fired or asked to resign from a job? *

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On what start date would you be available to work? *
Days and Hours Available: (If employed, I will notify my supervisor in writing, should my availability change.) *
ShiftSunMonTueWedThuFriSat
Days (6am-2pm)
Evenings (2pm-10pm)
Nights (10pm-6am)

Education

High School
College
Graduate
Vocational

Please list any academic honors, scholarships, offices held, etc.


Describe any specialized training, apprenticeships, licenses or skills.


Have you received any job-related training in the United States Military? *

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EMPLOYMENT HISTORY (1. Begin with current or most recent employer. 2. Do not exclude any employment. 3. Include any applicable temporary employment. Previous salaries or wages will not be used to determine compensation at Valley Cares, Inc.)





Please provide any other information that you feel will help us in considering your application for employment.


REFERENCES (Please list three people who are not related to you – preferably previous supervisors – who can provide professional references.)

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APPLICANT ACKNOWLEDGEMENT AND AUTHORIZATION

*PLEASE READ CAREFULLY BEFORE SIGNING*

I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery.

I understand that submission of an application does not guarantee employment. I further understand that, should an offer of employment be extended by Valley Cares, Inc. that such employment with Valley Cares, Inc. is at will, for no specified duration and may be terminated by either Valley Cares, Inc. or myself at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements of Valley Cares, Inc. or its representatives used during the employment process is deemed a contract of employment real or implied. In consideration for employment with Valley Cares, Inc., if employed, I agree to conform to the rules, regulations, policies and procedures of Valley Cares, Inc. at all times and understand that such obedience is a condition of employment. I understand that due to the nature of Valley Cares, Inc. business, attendance and punctuality are considered essential requirements of every job at Valley Cares, Inc. and that poor attendance or tardiness will result in disciplinary action.

I understand that if offered a position with Valley Cares, Inc., I may be required to submit to a pre-employment medical examination, drug screening and background check as a condition of employment. I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these preemployments tests and checks will result in withdrawal of any employment offer or termination of employment if already employed.

I herby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to Valley Cares, Inc. and/or any of its representatives, agents or vendors and I release all parties involved from any and all liability for any and all damage that may result from providing such information.

I understand that this application is considered current for three months. If I wish to be considered for employment after this period I must fill out and submit a new application.

BY SIGNING BELOW I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE STATEMENTS.

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Name and number of person completing this form if other than applicant:


Type the Security Image then click SEND APPLICATION:

* Security Image

VALLEY CARES, INC. IS PROUD TO BE AN EQUAL OPPORTUNITY EMPLOYER. ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, AGE, DISABILITY, VETERAN STATUS OR ANY OTHER STATUS PROTECTED BY LAW.