{"id":162,"date":"2011-09-22T13:36:01","date_gmt":"2011-09-22T13:36:01","guid":{"rendered":"http:\/\/staugcenterforliving.com\/?page_id=162"},"modified":"2011-09-22T13:36:01","modified_gmt":"2011-09-22T13:36:01","slug":"employment-form","status":"publish","type":"page","link":"https:\/\/staugcenterforliving.com\/index.php\/employment-form\/","title":{"rendered":"Employment Form"},"content":{"rendered":"<div class=\"wpcf7\" id=\"wpcf7-f161-p162-o1\"><form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/162#wpcf7-f161-p162-o1\" method=\"post\" class=\"wpcf7-form\" novalidate=\"novalidate\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"161\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"3.4.2\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f161-p162-o1\" \/>\n<input type=\"hidden\" name=\"_wpnonce\" value=\"a5f2d6adba\" \/>\n<\/div>\n<fieldset>\n<label>Name:<\/label> <span class=\"wpcf7-form-control-wrap name\"><input type=\"text\" name=\"name\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" placeholder=\"First, Last Middle\" \/><\/span><br \/>\n<label>Address:<\/label> <span class=\"wpcf7-form-control-wrap address\"><input type=\"text\" name=\"address\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" placeholder=\"Street - City - State, Zip\" \/><\/span><br \/>\n<label>Mailing Address:<\/label> <span class=\"wpcf7-form-control-wrap maddress\"><input type=\"text\" name=\"maddress\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" placeholder=\"If different from above\" \/><\/span><br \/>\n<label>Telephone #:<\/label> <span class=\"wpcf7-form-control-wrap phone\"><input type=\"text\" name=\"phone\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Florida Driver's Lic #:<\/label> <span class=\"wpcf7-form-control-wrap dlic\"><input type=\"text\" name=\"dlic\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><\/p>\n<h2>Position<\/h2>\n<p><label>Position for which you are applying:<\/label> <span class=\"wpcf7-form-control-wrap position\"><input type=\"text\" name=\"position\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Shift preferred:<\/label> <span class=\"wpcf7-form-control-wrap shift\"><select name=\"shift\" class=\"wpcf7-form-control wpcf7-select\"><option value=\"Day\">Day<\/option><option value=\"Noon\">Noon<\/option><option value=\"Evening\">Evening<\/option><option value=\"Night\">Night<\/option><option value=\"Weekends Only\">Weekends Only<\/option><option value=\"Any\">Any<\/option><\/select><\/span><br \/>\n<\/fieldset>\n<fieldset>\n<legend>Education: (Documentation of education will be required)<\/legend>\n<p><label>Highest grade completed:<\/label> <span class=\"wpcf7-form-control-wrap hgrade\"><select name=\"hgrade\" class=\"wpcf7-form-control wpcf7-select\"><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/option><option value=\"10\">10<\/option><option value=\"11\">11<\/option><option value=\"12\">12<\/option><option value=\"GED\">GED<\/option><option value=\"College\">College<\/option><\/select><\/span><br \/>\n<label>College(s) Attended:<\/label> <span class=\"wpcf7-form-control-wrap colleges\"><input type=\"text\" name=\"colleges\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Major field of study:<\/label> <span class=\"wpcf7-form-control-wrap major\"><input type=\"text\" name=\"major\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Degree(s) earned:<\/label> <span class=\"wpcf7-form-control-wrap degrees\"><input type=\"text\" name=\"degrees\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><\/p>\n<h2>Military Service<\/h2>\n<p><label>Branch of military service:<\/label> <span class=\"wpcf7-form-control-wrap branch\"><input type=\"text\" name=\"branch\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Date of discharge:<\/label> <span class=\"wpcf7-form-control-wrap ddate\"><input type=\"text\" name=\"ddate\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>National Guard:<\/label> <span class=\"wpcf7-form-control-wrap nguard\"><input type=\"text\" name=\"nguard\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Date obligation ends:<\/label> <span class=\"wpcf7-form-control-wrap odate\"><input type=\"text\" name=\"odate\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><\/p>\n<h2>Additional Experience<\/h2>\n<p><label>Special training or certifications:<\/label> <span class=\"wpcf7-form-control-wrap certs\"><input type=\"text\" name=\"certs\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Hobbies, interests, volunteer experience:<\/label> <span class=\"wpcf7-form-control-wrap hobbies\"><input type=\"text\" name=\"hobbies\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<\/fieldset>\n<fieldset>\n<legend>Previous Work Experience (Begin with most recent)<\/legend>\n<div>\n<label>Name of Company:<\/label> <span class=\"wpcf7-form-control-wrap cname1\"><input type=\"text\" name=\"cname1\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Supervisor:<\/label> <span class=\"wpcf7-form-control-wrap sup1\"><input type=\"text\" name=\"sup1\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Address:<\/label> <span class=\"wpcf7-form-control-wrap add1\"><input type=\"text\" name=\"add1\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Telephone:<\/label> <span class=\"wpcf7-form-control-wrap tele1\"><input type=\"text\" name=\"tele1\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Job Title\/Duties:<\/label> <span class=\"wpcf7-form-control-wrap dut1\"><input type=\"text\" name=\"dut1\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Dates of Employment:<\/label> <span class=\"wpcf7-form-control-wrap dat1\"><input type=\"text\" name=\"dat1\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" placeholder=\"MM\/YY to MM\/YY\" \/><\/span><br \/>\n<label>Starting\/Ending Pay:<\/label> <span class=\"wpcf7-form-control-wrap pay1\"><input type=\"text\" name=\"pay1\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" placeholder=\"$$\/hr - $$\/hr or $$\/yr\" \/><\/span><br \/>\n<label>Reason for leaving:<\/label> <span class=\"wpcf7-form-control-wrap reas1\"><input type=\"text\" name=\"reas1\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span>\n<\/div>\n<div>\n<label>Name of Company:<\/label> <span class=\"wpcf7-form-control-wrap cname2\"><input type=\"text\" name=\"cname2\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Supervisor:<\/label> <span class=\"wpcf7-form-control-wrap sup2\"><input type=\"text\" name=\"sup2\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Address:<\/label> <span class=\"wpcf7-form-control-wrap add2\"><input type=\"text\" name=\"add2\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Telephone:<\/label> <span class=\"wpcf7-form-control-wrap tele2\"><input type=\"text\" name=\"tele2\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Job Title\/Duties:<\/label> <span class=\"wpcf7-form-control-wrap dut2\"><input type=\"text\" name=\"dut2\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Dates of Employment:<\/label> <span class=\"wpcf7-form-control-wrap dat2\"><input type=\"text\" name=\"dat2\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" placeholder=\"MM\/YY to MM\/YY\" \/><\/span><br \/>\n<label>Starting\/Ending Pay:<\/label> <span class=\"wpcf7-form-control-wrap pay2\"><input type=\"text\" name=\"pay2\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" placeholder=\"$$\/hr - $$\/hr or $$\/yr\" \/><\/span><br \/>\n<label>Reason for leaving:<\/label> <span class=\"wpcf7-form-control-wrap reas2\"><input type=\"text\" name=\"reas2\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span>\n<\/div>\n<div>\n<label>Name of Company:<\/label> <span class=\"wpcf7-form-control-wrap cname3\"><input type=\"text\" name=\"cname3\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Supervisor:<\/label> <span class=\"wpcf7-form-control-wrap sup3\"><input type=\"text\" name=\"sup3\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Address:<\/label> <span class=\"wpcf7-form-control-wrap add3\"><input type=\"text\" name=\"add3\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Telephone:<\/label> <span class=\"wpcf7-form-control-wrap tele3\"><input type=\"text\" name=\"tele3\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Job Title\/Duties:<\/label> <span class=\"wpcf7-form-control-wrap dut3\"><input type=\"text\" name=\"dut3\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Dates of Employment:<\/label> <span class=\"wpcf7-form-control-wrap dat3\"><input type=\"text\" name=\"dat3\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" placeholder=\"MM\/YY to MM\/YY\" \/><\/span><br \/>\n<label>Starting\/Ending Pay:<\/label> <span class=\"wpcf7-form-control-wrap pay3\"><input type=\"text\" name=\"pay3\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" placeholder=\"$$\/hr - $$\/hr or $$\/yr\" \/><\/span><br \/>\n<label>Reason for leaving:<\/label> <span class=\"wpcf7-form-control-wrap reas3\"><input type=\"text\" name=\"reas3\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span>\n<\/div>\n<div>\n<label>Name of Company:<\/label> <span class=\"wpcf7-form-control-wrap cname1\"><input type=\"text\" name=\"cname1\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Supervisor:<\/label> <span class=\"wpcf7-form-control-wrap sup4\"><input type=\"text\" name=\"sup4\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Address:<\/label> <span class=\"wpcf7-form-control-wrap add4\"><input type=\"text\" name=\"add4\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Telephone:<\/label> <span class=\"wpcf7-form-control-wrap tele4\"><input type=\"text\" name=\"tele4\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Job Title\/Duties:<\/label> <span class=\"wpcf7-form-control-wrap dut4\"><input type=\"text\" name=\"dut4\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Dates of Employment:<\/label> <span class=\"wpcf7-form-control-wrap dat4\"><input type=\"text\" name=\"dat4\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" placeholder=\"MM\/YY to MM\/YY\" \/><\/span><br \/>\n<label>Starting\/Ending Pay:<\/label> <span class=\"wpcf7-form-control-wrap pay4\"><input type=\"text\" name=\"pay4\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" placeholder=\"$$\/hr - $$\/hr or $$\/yr\" \/><\/span><br \/>\n<label>Reason for leaving:<\/label> <span class=\"wpcf7-form-control-wrap reas4\"><input type=\"text\" name=\"reas4\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span>\n<\/div>\n<h2>Additional Employment Questions<\/h2>\n<p><label>Are you presently employed?<\/label> <span class=\"wpcf7-form-control-wrap pemploy\"><input type=\"text\" name=\"pemploy\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>May we contact your ex-employer?<\/label> <span class=\"wpcf7-form-control-wrap cex\"><input type=\"text\" name=\"cex\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Date of last physical:<\/label> <span class=\"wpcf7-form-control-wrap lphys\"><input type=\"text\" name=\"lphys\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Have you worked for this company before?<\/label> <span class=\"wpcf7-form-control-wrap wbef\"><input type=\"text\" name=\"wbef\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><\/p>\n<h3>If so:<\/h3>\n<p><label>What position?<\/label> <span class=\"wpcf7-form-control-wrap befpos\"><input type=\"text\" name=\"befpos\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Dates worked:<\/label> <span class=\"wpcf7-form-control-wrap befdate\"><input type=\"text\" name=\"befdate\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<label>Reason for leaving:<\/label> <span class=\"wpcf7-form-control-wrap befreas\"><input type=\"text\" name=\"befreas\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" \/><\/span><br \/>\n<\/fieldset>\n<fieldset>\n<legend>PLEASE READ THE FOLLOWING CAREFULLY:<\/legend>\n<h2>Hiring procedures will include the following:<\/h2>\n<ol>\n<li>Reference checks of previous employers.<\/li>\n<li>Review of letters of reference (3)<\/li>\n<li>Review of transcripts of required certifications, licenses, degrees as required for position<\/li>\n<li>Abuse registry background check, *fingerprinting, FBI and Sheriff screening<\/li>\n<li>Physical examination<\/li>\n<\/ol>\n<p>To determine my qualifications for employment, I authorize this company to conduct an investigation of my application. I understand that any false or misleading information furnished by men on this application form or in connection with my application for employment may result in rejection of the application, or if employed by this company, in the termination of employment.<\/p>\n<div>\n<label>Signature:<\/label> <span class=\"wpcf7-form-control-wrap sig\"><input type=\"text\" name=\"sig\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" placeholder=\"Please type your full name.\" \/><\/span><br \/>\n<label>Date:<\/label> <span class=\"wpcf7-form-control-wrap sigdate\"><input type=\"text\" name=\"sigdate\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" placeholder=\"Please type today&#039;s date.\" \/><\/span>\n<\/div>\n<\/fieldset>\n<fieldset id=\"qs\">\n<legend>Please answer the following:<\/legend>\n<p><label>1. Describe the reasons why you left your last position.<\/label><span class=\"wpcf7-form-control-wrap num1\"><textarea name=\"num1\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" placeholder=\"Include whether you left voluntarily, were laid off or terminated. If you are still employed, describe the reasons you want to leave.\"><\/textarea><\/span><br \/>\n<label>2. What did you like most about your last job?<\/label><span class=\"wpcf7-form-control-wrap num2\"><textarea name=\"num2\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\"><\/textarea><\/span><br \/>\n<label>3. What did you like least about your last job?<\/label><span class=\"wpcf7-form-control-wrap num3\"><textarea name=\"num3\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\"><\/textarea><\/span><br \/>\n<label>4. What does \u201cDevelopmentally Challenged\u201d mean to you?<\/label><span class=\"wpcf7-form-control-wrap num4\"><textarea name=\"num4\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\"><\/textarea><\/span><br \/>\n<label>5. A client strikes you. Would you punish him? If so, how? If so, why not?<\/label><span class=\"wpcf7-form-control-wrap num5\"><textarea name=\"num5\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\"><\/textarea><\/span><br \/>\n<label>6. Why do you feel you are qualified to work at the Center for Living?<\/label><span class=\"wpcf7-form-control-wrap num6\"><textarea name=\"num6\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\"><\/textarea><\/span><br \/>\n<label>7. What do you expect from a job at the Center for Living?<\/label><span class=\"wpcf7-form-control-wrap num7\"><textarea name=\"num7\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\"><\/textarea><\/span><br \/>\n<label>8. What will you contribute to the Center for Living if hired?<\/label><span class=\"wpcf7-form-control-wrap num8\"><textarea name=\"num8\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\"><\/textarea><\/span><br \/>\n<\/fieldset>\n<fieldset>\n<input type=\"hidden\" name=\"_wpcf7_captcha_challenge_captcha-402\" value=\"1317450514\" \/><img loading=\"lazy\" decoding=\"async\" class=\"wpcf7-form-control wpcf7-captchac wpcf7-captcha-captcha-402\" width=\"84\" height=\"28\" alt=\"captcha\" src=\"https:\/\/staugcenterforliving.com\/wp-content\/uploads\/wpcf7_captcha\/1317450514.png\" \/><br \/>\nPlease enter what you see above in the box below:<br \/>\n<span class=\"wpcf7-form-control-wrap captcha-402\"><input type=\"text\" name=\"captcha-402\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-captchar\" \/><\/span><br \/>\n<\/fieldset>\n<p><input type=\"submit\" value=\"Submit Application\" class=\"wpcf7-form-control wpcf7-submit\" id=\"submit\" \/><\/p>\n<div class=\"wpcf7-response-output wpcf7-display-none\"><\/div><\/form><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-162","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/staugcenterforliving.com\/index.php\/wp-json\/wp\/v2\/pages\/162","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/staugcenterforliving.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/staugcenterforliving.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/staugcenterforliving.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/staugcenterforliving.com\/index.php\/wp-json\/wp\/v2\/comments?post=162"}],"version-history":[{"count":1,"href":"https:\/\/staugcenterforliving.com\/index.php\/wp-json\/wp\/v2\/pages\/162\/revisions"}],"predecessor-version":[{"id":163,"href":"https:\/\/staugcenterforliving.com\/index.php\/wp-json\/wp\/v2\/pages\/162\/revisions\/163"}],"wp:attachment":[{"href":"https:\/\/staugcenterforliving.com\/index.php\/wp-json\/wp\/v2\/media?parent=162"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}