ABRiO Careers11 | ABRiO Care

Cities/Location you want to apply for?*

Phoenix area
Flagstaff area
Kingman/Mohave County
Prescott/Prescott Valley area
Verde Valley area
Yuma area
Mesa area

Terms of Application

In order to be considered for this position, you will be required to fill out a Criminal History Self Disclosure Affidavit when you come in to the office. This is used to apply for a Level 1 Fingerprint card. Your fingerprints will be submitted to the Arizona Department of Public Safety(DPS) and the Federal Bureau of Investigation(FBI) for a criminal history check. Your self-disclosure on this affidavit and the information provided by your criminal history check will be used, as authorized by Public Law and Arizona Revised Statues, to help us determine your fitness to have unsupervised access to vulnerable persons. Your failure to disclose true and accurate information on this affidavit will be sufficient grounds to end your employment or to deny, suspend, or revoke your license and may be referred to the State Attorney General's Office for prosecution.

I understand and wish to continue the application.*

Yes
No

Personal Information

Date*

Name*

First Last

Middle Initial*

Prefers to be Called

Home Phone*

(###)###-####

Cell Phone*

(###)###-####

Do you have Internet access?*

Yes
No

Email*

Enter Email Confirm Email

Current Residential Address*

Street Address City State ZIP Code

Is your mailing address different from your residential address?*

Yes
No

Permanent Mailing Address*

Street Address City State ZIP Code

Emergency Contact Person*

First Last

Relationship*

Phone*

(###)###-####

Email

Address*

Street Address City State ZIP Code

Are you eligible to work in the U.S.?*

Yes
No

Are you at least 18 years old?*

Yes
No

Are you able to work flexible hours?*

Yes
No

Do you have a relative employed with us?*

Yes
No

Have you ever applied here before?*

Yes
No

What type of work are you applying for?*

Developmentally Disabled Adults
Developmentally Disabled Children
Elderly / Aging Services
Other

Please specify other:*

Minimum hourly rate?*

Please enter a number from 1.00 to 500.00.

e.g. 15.00

Date Available?*

What type of employment do you want?*

full-time
part-time
summer
school year

Available to work: Monday*

AM	PM

Tuesday*

AM	PM

Wednesday*

AM	PM

Thursday*

AM	PM

Friday*

AM	PM

Saturday*

AM	PM

Sunday*

AM	PM

Available for Overnight Shifts:*

Yes
No

Days*

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Available for work with short notice:*

Yes
No

Education

Did you attend High School?*

Yes
No

Name*

Address*

Street Address City State ZIP Code

Highest Grade Completed*

Did you graduate?*

Yes
No

GED?*

Yes
No

Attended Business or Technical School?*

Yes
No

Name*

Address*

Street Address City State ZIP Code

Years completed*

Did you graduate?*

Yes
No

Did you receive a degree/certificate?*

Yes
No

Attended a University and/or College?*

Yes
No

Name*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Major/Field of Study*

Degree/Years Completed*

e.g. Bachelors Degree or 3 years towards Bachelors Degree

2nd University and/or College*

Yes
No

Name*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Major/Field of Study*

Degree/Years Completed*

e.g. Bachelors Degree or 3 years towards Bachelors Degree

Military Service

Have you ever served in the Military?*

Yes
No

Branch*

Date Entered*

Date Discharged*

Highest Rank*

Special Trainings and/or Qualifications

Current Certifications/Licenses (documentation is required):*

C.P.R

Only .pdf, .doc, .docx, .txt are accepted file formats

First Aid

Only .pdf, .doc, .docx, txt are accepted file formats

P&S

Only .pdf, .doc, .docx, .txt are accepted file formats

C.N.A

Only .pdf, .doc, .docx, .txt are accepted file formats

L.P.N.

Only .pdf, .doc, .docx, .txt are accepted file formats

R.N.

Only .pdf, .doc, .docx, .txt are accepted file formats

Article 9

Only .pdf, .doc, .docx, .txt are accepted file formats

DCW Fundamentals

Only .pdf, .doc, .docx, .txt are accepted file formats

DCW Dev Disabilities

Only .pdf, .doc, .docx, .txt are accepted file formats

DCW Aging & Phys Disabled

Only .pdf, .doc, .docx, .txt are accepted file formats

DCW Skills

Only .pdf, .doc, .docx, .txt are accepted file formats

In Home Certification

Only .pdf, .doc, .docx, .txt are accepted file formats

Do you have prior experience working with people with Developmental Disabilities?*

Yes
No

Do you have prior experience working with individuals with physical disabilities?*

Yes
No

Are you able to lift 50 lbs.?*

Yes
No

Do you speak another language other than English?*

Yes
No

If yes, please list below

Language List*

Fingerprint Clearance

A fingerprint clearance is a requirement for employment.

Have you ever been convicted of a crime?*

Yes
No

If Yes, please list conviction(s) and date(s)

List*

Convictions(s)	Date(s)

Driving Information

Driving for ABRiO is not a requirement but if would like to be able to drive a company vehicle or be able to transport clients you must fill out your your drivers information.

Do you want to drive with or for ABRiO?*

Yes
No

*

Driver's License Number	State	Expiration Date

Do you have a clean driving record?*

Yes
No

Have you ever been found at fault for a motor vehicle accident in the past five years?*

Yes
No

Have you received a ticket for a moving violation in the past five years?*

Yes
No

Explain any of the above:*

Employment Record

List the most recent employment first. Include former employers and self employment.

Employment History?*

1
2
3
No

You can choose up to three employers

Employer's Name*

Phone*

(###)###-####

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Supervisor's Name*

Supervisor's Title*

Your Job Title*

from Date*

to Date*

Pay*

Start	End

Reason for Leaving*

Describe Duties*

Employer's Name*

Phone*

(###)###-####

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Supervisor's Name*

Supervisor's Title*

Your Job Title*

from Date*

to Date*

Pay*

Start	End

Reason for Leaving*

Describe Duties*

Employer's Name*

Phone*

(###)###-####

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Supervisor's Name*

Supervisor's Title*

Your Job Title*

from Date*

to Date*

Pay*

Start	End

Reason for Leaving*

Describe Duties*

Professional References

Provide the names of three persons (not related to you) whom you have either worked with or worked for and who you have known for at least 1 year. Addresses and phone numbers must be included for application to be accepted.

Name*

First Last

Phone*

(###)###-####

Years Known*

Relationship*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Name*

First Last

Phone*

(###)###-####

Years Known*

Relationship*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Name*

First Last

Phone*

(###)###-####

Years Known*

Relationship*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Personal References

Provide the names of three persons (not related to you) whom you have known for at least 1 year. Address and valid phone numbers must be included for application to be accepted.

Would you like to include personal references?*

Yes
No

Name*

First Last

Phone*

(###)###-####

Years Known*

Relationship*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Name*

First Last

Phone*

(###)###-####

Years Known*

Relationship*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Name*

First Last

Phone*

(###)###-####

Years Known*

Relationship*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Please include your Rèsumè

Only .pdf, .doc, .docx, .txt are accepted file formats

I certify that the above information is true and complete to the best of my knowledge. I understand that misrepresentation or omission of facts requested on this application is cause for rejection of this application or for subsequent dismissal from employment. I authorize an investigation of any of the facts set forth in this application. I give permission to check my educational background, references, professional license, criminal record, and credit report and release any and all person, companies, or agencies responding to such investigation from any liability for any damage due to releasing information pertaining hereto. I understand I will be required to provide information for compliance with the Immigration Reform and Control Act. I understand that I may be required to have a drug test and pre-employment evaluation. I understand and agree that my employment with ABRiO is entered into voluntarily and I may resign at any time.

I agree*

Yes
No

Date*

How did you hear about ABRiO?*

Search Engine
Radio
AZ Job Service
Newspaper Ad
Flyer posted around town
Craigslist
Other
Referred by an ABRiO employee?

Other*

Please tell us who we can thank?*

Name must be included at the time of the application to be eligible for any referral bonus to be made.

Comments

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