Back APPLICATION FOR EMPLOYMENT Step 1 of 7 14% At which location would you like to apply?(Required) Tulsa Muskogee Oklahoma City Enid Woodward Name(Required) First Last Preferred Phone(Required)Alternate PhoneEmail(Required) Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Position applying for(Required) H.T.S. P.C. Other Other position: How did you hear about this position at Independent Opportunities, Inc.?(Required) Current employee Internet website Newspaper ad Transitioning from another agency with consumer Walk in Word of mouth Other Name of employee Name of website Name of newspaper Name of consumer Other Have you ever applied for a job with IOI before?(Required) Yes No When Have you ever been employed by IOI before?(Required) Yes No When Are you interested in full-time or part-time work?(Required) Full Time Part Time What hours and days are you available to work?(Required) What date are you available to start work?(Required) MM slash DD slash YYYY May we contact your current employer?(Required) Yes No Are you authorized to work in the United States?(Required) Yes No Do you have a valid Driver’s License?(Required) Yes No Issued in what state?AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificHave you ever been convicted of or pled guilty, nolo contendere or no contest to a criminal offense other than a minor traffic violation?(Required)(A yes answer will not necessarily disqualify you from employment) Yes No Please explain:Are there any pending criminal charges against you for an offense other than a minor traffic violation?(Required)(A yes answer will not necessarily disqualify you from employment) Yes No Please explain:Are you related to anyone employed by IOI?(Required) Yes No Whom? Relationship Educational BackgroundHigh School Name of schoolCourse of Study # of Years CompletedDegree/Diploma College Name of collegeCourse of Study # of Years CompletedDegree/Diploma Post Graduate Name of UniversityCourse of Study # of Years CompletedDegree/Diploma Other Education Course of Study # of Years CompletedDegree/Diploma EMPLOYMENT EXPERIENCEList all employers for the past ten (10) years beginning with your most recent employment. Please explain gaps in employment history of more than 30 days.Load as many past experience as nessesary. Company Name Address Phone Job Duties Supervisor Name Start Date End Date Reason for Leaving Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Have you worked before with people who have developmental disabilities?(Required) Yes No Please mark any of the below training in which you are currently certified: Foundations CPR First Aid MAT ETL ETL2 PA1 PA2 Mealtime Challenges Residential Modules Other Certifications When does your CPR training expire? MM slash DD slash YYYY When does your First Aid training expire? MM slash DD slash YYYY When does your MAT training expire? MM slash DD slash YYYY Other Certifications Independent Opportunities, Inc. primary purpose is to assist persons with developmental disabilities to reach their highest potential in everyday settings. Consequently, among the essential functions of an IOI job is the ability to bend at the waist, kneel, stoop and lift 50 pounds.(Required)Can you perform these essential job functions either with or without reasonable accommodation? Yes No By signing this application you acknowledge that you have read, understand and agree to the following(Required)1. I hereby certify that the facts stated in this application are true and correct to the best of my knowledge. I agree that any false or inaccurate information in this application is sufficient reason for IOI to refuse to hire me and, if hired, to terminate my employment. 2. IOI is not obligated to provide me with employment and I am not obligated to accept employment. Nothing in this employment application or anything communicated to me during an interview is intended to create an employment contract between IOI and me. 3. If I am employed by IOI, my employment will be at-will which means that either IOI or I may terminate the employment relationship at any time, for any lawful reason, with or without prior notice. IOI’s employment-at-will policy may not be modified verbally by any person and may not be modified by a written statement appearing in an IOI policy or document other than a formal written employment agreement signed by IOI’s Executive Director. 4. If I am hired, I will be required to provide documentation of my identity and my employment eligibility in the United States in accordance with the Immigration Reform and Control Act of 1986. 5. Illegal use, impairment, or sale of narcotic, or controlled substances (without a doctor’s prescription) or alcohol while on IOI property, at a remote worksite to which I am assigned to work, or while driving during the course of my employment is strictly prohibited. I agree to abide by the Alcohol and Drug Free workplace and testing policies of this company. Any violation of these standards may result in immediate termination of my employment. 6. I authorize IOI to conduct a criminal background check and any other background check required as a condition of my employment by statute, regulation or other law or by a governmental agency. I agree to the terms listed above.Human VerificationSignature(Required)
