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Position Sought*

First Name*

Last Name*

Phone*

Email*

Address*

Street Address City State ZIP Code

General Information

Work Availability (check all that apply)*

Are you 18 years of age or older?*

Yes
No

Have you previously worked for Aspire?*

Yes
No

Do you possess a valid driver's license?*

Yes
No

Have you ever been convicted of a Felony or Misdemeanor?*

Yes
No

Are there any pending criminal charges against you?*

Yes
No

Do you have a minimum of a high school diploma (or equivalent)?*

Yes
No

Employment History

1) Current or Most Recent Employer

Name of Business/Organization*

Job Title*

Number of Hours Worked*

Hourly Rate $*

Date Started*

Date Left*

Reason for Leaving*

2) Second Most Recent Employer

Name of Business/Organization

Job Title

Number of Hours Worked

Hourly Rate $

Date Started

Date Left

Reason for Leaving

3) Third Most Recent Employer

Name of Business/Organization

Job Title

Number of Hours Worked

Hourly Rate $

Date Started

Date Left

Reason for Leaving

Optional Resume (pdf, doc, docx)

Drop files here or

Applicant Agreement

Aspire of WNY is an Equal Opportunity Employer. Qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, disability, veteran, marital status, sexual orientation or any other protected class under Federal and/or State laws. I authorize Aspire of WNY to verify any of the information provided on this application. I authorize all persons, schools, companies, organizations, and law enforcement authorities to release any information concerning my background. This includes but is not limited to: criminal activity/history checks and motor vehicle driving records. Certain positions at Aspire of WNY have been designated as a position that is required to complete a fingerprinted background check under Section 16.33 of the New York State Mental Hygiene Law, Section 845-b of the Executive Law and 14NYCRR Section 633.22. I hereby release these persons from any liability for furnishing this information. I understand and agree that as part of Aspire's overall employment policy, pre-employment testing for illegal use of drugs will be performed. I affirm I have read this completed application and have not withheld any information and that the information that I have furnished is true and correct. A false answer to any question, misleading statement and/or any omitted information in the application process is grounds for terminating the application process or, if discovered after employment, terminating employment.

By initialing here I agree that I have read and understood the above applicant agreement*

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