VISIONS Employee Application | VISIONS/Services for the Blind and Visually Impaired

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VISIONS/Services for the Blind and Visually Impaired

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VISIONS Employment Services

Job Application

PERSONAL INFORMATION

Application Date
Last Name
First Name
Middle Name
Address
City
State
Zip Code
Home Phone
Cell Phone

POSITION DESIRED

Position Desired:
Date Available:
Have you ever applied here before?	Yes No
If so, date and position applied for:
Can you, after employment, submit verification of your identity and legal right to work in the United States?	Yes No
Employment type desired:	Full Time
	Part Time
	Temporary
	Internship
	Summer
What prompted you to apply here?	Advertisement
	Refferal
	Agency
	Other
Are you 18 years of age or older?	Yes No
HAVE YOU EVER APPLIED FOR OR BEEN EMPLOYED BY VISIONS, VCB OR SELIS MANOR?	Yes No
If yes, date and position applied for:
DOES OR HAS ANY RELATIVE WORKED FOR VISIONS, VCB OR SELIS MANOR?
If yes, name relationship, date and position
DOES OR HAS ANY RELATIVE WORKED FOR THE NYC DEPARTMENT FOR THE AGING OR THE NYS COMMISSION FOR THE BLIND AND VISUALLY HANDICAPPED?	Yes No
If yes, name relationship, date and position:
HAVE YOU EVER BEEN CONVICTED OF A CRIME OR HAVE A PENDING ARREST THAT HAS NOT BEEN EXPUNGED, SEALED OR PARDONED?	Yes No
If yes, when?
A criminal conviction will not necessarily be a bar to employment. To help us evaluate your application, please describe the nature of the offense for which you were convicted, the circumstances surrounding the commission of the offense and your subsequent rehabilitation.

EDUCATION & TRAINING

School	Major	Date	Degree




Other Training, Honors, and Awards

EXPERIENCE

	Most Recent Employer	Previous Employer	Previous Employer
Company
Address
Supervisor Name
Supervisor Phone
Your Job Title

	Job Description	Job Description	Job Description

Dates Employed
Salary

Name
Relationship
Phone
Address

REFERENCES

SINCE EMPLOYMENT IS CONTINGENT UPON A SATISFACTORY BACKGROUND REVIEW AND HIRING IS PROVISIONAL BASED ON VERIFICATION OF INFORMATION, I AUTHORIZE VISIONS TO COMPLETE A BACKGROUND CHECK. WE ASSURE YOU THAT WE TAKE STRICT PRECAUTIONS IN PROTECTING YOUR PERSONAL INFORMATION.

Please check this box if you have read, fully understand this application and agree to the conditions above.
Date:

We have also provided a downloadable printable version of our application. Please return it completed to:

VISIONS at Selis Manor
135 West 23rd Street 1st Floor
New York, NY 10011

Tel: 646-486-4444
Fax: 646-486-4343

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