Select the jobs you would like to apply for:

Fields marked with an asterisk (*) must be filled out before submitting.

PERSONAL

NAME *
Telephone *
Email
 
Address
City
State
Zip
 
Are you legally eligible for employment in the United States? If hired you are required to provide proof of your eligibility to work in the United States. * Yes
No
 
Are you over the age of eighteen? If no, hire is subject to verification that you are of minimum legal age for employment. * Yes
No
 
Were you previously employed by Elmhurst, Inc.? * Yes
No
If yes, when?
 
If your application is considered favorably, on what date would you be available for work? *
 
Have you been convicted of a felony? (Conviction is not necessarily a bar to employment.) * Yes
No
 
Do you hold a valid Drivers License? * Yes
No
 

EDUCATION

High School

Name *
Years Completed *

College

Name
Years Completed
Course of Study
US Military Service

PREVIOUS EMPLOYMENT

(Please begin with your most recent or current employer)

Employer I

Name of Employer
Telephone
Dates of Employment
Job Title
Reason for Leaving
Name of Supervisor
I hereby give Elmhurst, Inc. permission to contact the above employer listed herein concerning my prior work experience. Yes
No

Employer II

Name of Employer
Telephone
Dates of Employment
Job Title
Reason for Leaving
Name of Supervisor
I hereby give Elmhurst, Inc. permission to contact the above employer listed herein concerning my prior work experience. Yes
No

Employer III

Name of Employer
Telephone
Dates of Employment
Job Title
Reason for Leaving
Name of Supervisor
I hereby give Elmhurst, Inc. permission to contact the above employer listed herein concerning my prior work experience. Yes
No

Employer IV

Name of Employer
Telephone
Dates of Employment
Job Title
Reason for Leaving
Name of Supervisor
I hereby give Elmhurst, Inc. permission to contact the above employer listed herein concerning my prior work experience. Yes
No

Employer V

Name of Employer
Telephone
Dates of Employment
Job Title
Reason for Leaving
Name of Supervisor
I hereby give Elmhurst, Inc. permission to contact the above employer listed herein concerning my prior work experience. Yes
No

SPECIAL SKILLS

Please list any knowledge, skills, or abilities which you feel make you especially suited for the position you are applying for
 
Membership in Professional Organizations
 
Current Licenses & Certifications
 
Computer Skills and Level of Proficiency

OTHER REFERENCES

Reference I

Name
Phone
Business
Years Known

Reference II

Name
Phone
Business
Years Known

Reference III

Name
Phone
Business
Years Known

APPLICATION QUESTIONS

In a few sentences, please tell us how you would go about teaching someone a new skill? *
 
In a few sentences, please tell us how you would assist someone with developmental disabilities to become an active part of their community? *
 
In a few sentences, please tell us what experiences you have had working with people with developmental disabilities and / or mental illness. *

APPLICANTS STATEMENT

I hereby authorize Elmhurst, Inc. to thoroughly investigate my references and other matters related to my suitability for employment, as indicated elsewhere in this application. I release Elmhurst, Inc., my current employer, and my former employers from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclose. * Agree
Disagree
 
I understand that any offer of employment is contingent upon satisfactory completion of a TB test (which Elmhurst, Inc. will provide at no expense to me.) I also understand that any offer of employment is contingent upon passing a pre-employment physical, if such physical is a requirement of the position. By signing this application, I voluntarily agree to submit to this physical. * Agree
Disagree
 
Upon receiving a conditional offer of employment, I will read and understand the Disclosure to Employment Applicant Regarding the Procurement of a Consumer Report. I understand, and agree, that any offer of employment is subject to a criminal background investigation. * Agree
Disagree
 
I understand that if driving is a requirement of the position, my employment is contingent upon holding a current and valid Maine drivers license. I give permission for Elmhurst, Inc. to conduct an investigation of my driving record. I understand that if I am hired and driving is required, I must show proof of a current minimum level (to be determined by Elmhurst, Inc.) of vehicle insurance and that a lapse in my insurance for any reason may be grounds for dismissal, if the position requires the transport of clients. * Agree
Disagree
 
I certify and verify that I am not currently, nor have I been in the last 12 months, an employee of the State of Maine (past service with the State of Maine does not necessarily bar the applicant from employment). * Agree
Disagree
 
I understand that nothing contained in the application or conveyed to me during any interview is intended to create an employment contract between myself and Elmhurst, Inc. I understand and agree that if I am employed, my employment relationship with Elmhurst, Inc. is at-will and at our mutual agreement. I understand that if employed, my employment is for no definite period and may be terminated at any time, with or without notice, with or without cause, at the option of either myself or Elmhurst, Inc. no promises or representations contrary to the foregoing are binding on Elmhurst, Inc. unless made in writing and signed jointly by the Executive Director and the Board of Directors and myself. * Agree
Disagree
 
I certify that the information supplied herein are true and complete to the best of my knowledge. I understand that, if employed, any false statements or act of omission on this application, on any documents used to secure my employment or during my interview(s) may result in dismissal. * Agree
Disagree
 
My signature here certifies that I have read and understand this complete page and agree to the terms and conditions outlined in this document. *
 
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