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Employment Application

Come work with us

Area Of Interest

check all that apply

Check any you are willing to accept
Availability

Check any you are willing to accept

Shifts

Education

High School:

Did You Graduate

College:

Did You Graduate

Others:

Did You Graduate

Prior Employment

Please give accurate, complete full time and part time employment record; start with the most present or most recent employer. Please include any previous employment with Thrive: Developmental Partners of Arkansas, Inc. and any other previous employer.

Employer #1:

Employer #2:

Employer #3:

Personal References

(Name three persons, not related to you, whom you have known for at least one year.)

(THIS IS IN COMPLIANCE WITH TITLE VI & TITLE VII OF THE CIVIL RIGHTS ACT OF 1964)

I hereby give permission for EMPLOYMENT & PERSONAL reference verification on the above.

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 Thrive: Developmental Partners of Arkansas, Inc. DOES NOT discriminate because of Sex, Race, Creed, Age, National origin, Religion, Handicap, or Veteran Status.

Name of any friends and relatives employed by Thrive: Developmental Partners of Arkansas, Inc.

Are you legally eligible for employment within the United States?
Yes
No
Are you eighteen years of age or older?
Yes
No
Do you have a valid Arkansas Driver’s Licenses
Yes
No
Have you ever been convicted of a misdemeanor or felony offense(s) in a court of law or military adjudication? If “Yes”, please indicate charge, where (court?) and when (time frame).
Yes
No
Have you ever been reprimanded or otherwise disciplined by a previous employer for violation of department or company policy?
Yes
No

 Pursuant to House Bill 1032, please indicate if you are responsible for child support or health insurance coverage for a minor dependent(s)?

Child Support
Yes
No
Health Insurance
Yes
No

I understand that employment is subject to verification of lawful age and legal right to work in the United States. I will submit such documents as may be necessary to verify lawful age and legal right to work in the United States.


DRUG SCREEN –All jobs are safety sensitive and medical marijuana use is prohibited.  I agree to submit (as TDPA policy states) to a drug test and hereby authorize the medical contractor performing the test to provide Thrive: Developmental Partners of Arkansas, Inc. a complete record and/or report. I understand that my conditional offer of employment is subject to the satisfactory completion of the drug test in compliance with the Thrive: Developmental Partners of Arkansas, Inc. Drug & Alcohol Free Work Place policy. If conditional offer of employment is offered I acknowledge I am still subject to TDPA policy of random and “for-cause” drug screens.


EMPLOYMENT SCREEN – I authorize Thrive: Developmental Partners of Arkansas, Inc., its employees, assigns, and agents to conduct an investigation of the information contained in this application or other matters concerning my past employment or other activities and to obtain or direct issuance of reports or other statements which may be furnished or obtained concerning same. I hereby release from liability and responsibility all persons, companies or corporations supplying such information and Thrive: Developmental Partners of Arkansas, Inc. in obtaining such information, and hereby release an law enforcement agency, the various military services, and/or their agents from liability of any kind for damages which may result from furnishing information about me.


CONVICTION STATEMENT – I understand that Thrive: Developmental Partners of Arkansas, Inc. is mandated to a Child Maltreatment Checks, Adult Maltreatment Checks, Criminal Background Checks, and Motor Traffic Record checks which may subject me to be disqualified depending upon the relationship of the report.


EMPLOYMENT AT WILL – I understand and agree that if employed, and as a condition of my employment, the employment will be “at will”. That is, either I or Thrive: Developmental Partners of Arkansas, Inc. may end the employment relationship at any time, for any reason, or for no reason. I further understand that no representatives of Thrive: Developmental Partners of Arkansas has authority to enter into any agreement with me for any specific period of time or make any agreement with me contrary to the foregoing. I understand that nothing contained in my employment application or in the granting of an interview is intended to create an employment contract between Thrive: Developmental Partners of Arkansas, Inc. are intended by reason of their publications to confer any rights or privileges to said benefits or policies, or to entitle me to be or remain employed by Thrive: Developmental Partners of Arkansas, Inc. or provisions in the handbook are procedural or are a guideline and Thrive: Developmental Partners of Arkansas, Inc. has the right to change any policy benefits or procedure at any time without notice.


TRUTH STATEMENT - I understand that any misleading or incorrect statements render this application void in the event of my employment prior to discovery of any falsehood regarding statements and records about and/or for me. I understand such activity is cause for immediate dismissal.


I have carefully read the above and fully understand. I certify that all statements on this application and supporting information in it are true and complete to the best of my knowledge.

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