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RISE LTD. JOB APPLICATION
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* Indicates required question
NAME
*
PLEASE ENTER FULL NAME
Your answer
STREET ADDRESS
*
Your answer
CITY AND STATE
*
Your answer
PHONE
*
Your answer
CELL PHONE
Your answer
E-MAIL
Your answer
BEST WAY TO CONTACT YOU?
*
PHONE CALL
EMAIL
POSITION APPLIED FOR
*
DAY PROGRAM STAFF
DIRECT SUPPORT STAFF IN HOMES
ADMINISTRATION
ANY AVAILABLE
Other:
Required
WHAT HOURS ARE YOU INTERESTED IN?
*
CHECK ALL HOURS YOU ARE INTERESTED IN
1ST SHIFT 8 AM TO 4 PM
2ND SHIFT 2PM TO 12AM
3RD SHIFT 12AM TO 8 AM
WEEKENDS ONLY
WOULD ACCEPT A CHANGING SCHEDULE OF THE ABOVE SHIFTS
Required
APPLYING FOR FULL TIME OR PART TIME?
*
FULL TIME
PART TIME
BOTH
Required
WHAT LOCATION ARE YOU APPLYING FOR?
*
ELKADER
OELWEIN
BOTH
Required
ARE YOU OVER THE AGE OF 18?
*
YES
NO
HAVE YOU BEEN EMPLOYED HERE BEFORE?
*
YES
NO
IF SO, WHEN WERE YOU EMPLOYED HERE?
Your answer
HAVE YOU APPLIED HERE BEFORE?
*
YES
NO
IF SO, WHEN DID YOU APPLY?
Your answer
ARE YOU LEGALLY AUTHORIZED TO WORK IN THE UNITED STATES?
*
YES
NO
EMPLOYMENT HISTORY
LIST THE LAST 3 POSITIONS, INCLUDING ANY EMPLOYMENT WITH RISE, LTD. INCLUDE ANY SUMMER, TEMPORARY, OR PART-TIME WORK.
NAME OF CURRENT OR MOST RECENT EMPLOYER (JOB #1)?
*
Your answer
PHONE NUMBER (JOB #1):
*
Your answer
JOB TITLE (JOB #1):
*
Your answer
ADDRESS (JOB #1):
*
Your answer
START DATE (JOB #1):
*
MM
/
DD
/
YYYY
END DATE (JOB #1):
*
MM
/
DD
/
YYYY
SUPERVISOR NAME (JOB #1):
*
Your answer
SUPERVISOR PHONE (JOB #1):
*
Your answer
YOUR JOB DUTIES: (JOB #1)
*
Your answer
REASON FOR LEAVING (JOB #1):
*
Your answer
MAY WE CONTACT THIS EMPLOYER (JOB #1)?
*
YES
NO
IF NO, PLEASE EXPLAIN (JOB #1):
Your answer
NAME OF PREVIOUS EMPLOYMENT (JOB #2):
Your answer
PHONE (JOB #2):
Your answer
JOB TITLE (JOB #2):
Your answer
ADDRESS (JOB #2):
Your answer
START DATE (JOB #2):
MM
/
DD
/
YYYY
END DATE (JOB #2):
MM
/
DD
/
YYYY
SUPERVISOR NAME (JOB #2):
Your answer
SUPERVISOR PHONE (JOB #2):
Your answer
YOUR JOB DUTIES (JOB #2):
Your answer
REASON FOR LEAVING (JOB #2):
Your answer
MAY WE CONTACT THIS EMPLOYER (JOB #2):
YES
NO
Clear selection
IF NO, PLEASE EXPLAIN (JOB #2):
YES
NO
Clear selection
NAME OF PREVIOUS EMPLOYMENT (JOB #3):
Your answer
PHONE (JOB #3):
Your answer
JOB TITLE (JOB #3):
Your answer
ADDRESS (JOB #3):
Your answer
START DATE (JOB #3):
MM
/
DD
/
YYYY
END DATE (JOB #3):
MM
/
DD
/
YYYY
SUPERVISOR NAME (JOB #3):
Your answer
SUPERVISOR PHONE (JOB #3):
Your answer
YOUR JOB DUTIES (JOB #3):
Your answer
REASON FOR LEAVING (JOB #3):
Your answer
MAY WE CONTACT THIS EMPLOYER (JOB #3):
YES
NO
Clear selection
IF NO, PLEASE EXPLAIN (JOB #3):
Your answer
EDUCATION
SELECT THE LAST GRADE COMPLETED OF HIGH SCHOOL:
*
1
2
3
4
5
6
7
8
9
10
11
12
NAME OF LAST HIGH SCHOOL
*
Your answer
ADDRESS OF LAST HIGH SCHOOL
*
Your answer
DID YOU GRADUATE FROM THIS SCHOOL AND RECEIVE A DIPLOMA?
*
YES
NO
IF YOU ANSWERED NO TO THE ABOVE QUESTION DID YOU EARN YOUR GED?
YES
NO
Clear selection
SELECT THE LAST YEAR COMPLETED OF COLLEGE:
1
2
3
4
5
6
7
8
Clear selection
NAME OF COLLEGE OR UNIVERSITY ATTENDED:
Your answer
ADDRESS OF COLLEGE OR UNIVERSITY ATTENDED:
Your answer
WHAT WAS YOUR MAJOR?
Your answer
WHAT WAS YOUR DEGREE?
Your answer
DID YOU GRADUATE?
YES
NO
Clear selection
NAME OF COMMERCIAL OR TRADE SCHOOL:
Your answer
ADDRESS OF COMMERCIAL OR TRADE SCHOOL:
Your answer
WHAT WAS YOUR MAJOR?
Your answer
WHAT WAS YOUR DEGREE?
Your answer
DID YOU GRADUATE?
YES
NO
Clear selection
SPECIAL SKILLS
LIST ANY SKILLS, QUALIFICATIONS, CLASSES, EXPERIENCES, CERTIFICATIONS OR TRAINING
Your answer
BACKGROUND
DO YOU HAVE A CURRENT VALID DRIVERS LICENSE?
*
YES
NO
IF ANSWERED NO, PLEASE EXPLAIN
Your answer
DO YOU HAVE MORE THAN 2 VIOLATIONS ON YOUR DRIVING RECORD IN THE LAST 3 YEARS
*
YES
NO
IF ANSWERED YES, PLEASE EXPLAIN
Your answer
HAVE YOU WORKED WITH THE MENTALLY ILL OR INTELLECTUALLY DISABLED?
*
YES
NO
IF ANSWERED YES, PLEASE EXPLAIN
Your answer
DO YOU HAVE A RECORD OF FOUNDED CHILD OR DEPENDENT ADULT ABUSE
*
YES
NO
IF ANSWERED YES, PLEASE EXPLAIN
Your answer
HAVE YOU EVER BEEN CONVICTED OF A CRIME IN THIS STATE OR ANY OTHER STATE?
*
YES
NO
IF ANSWERED YES, PLEASE EXPLAIN
Your answer
HAVE YOU EVER BEEN EXCLUDED FROM PARTICIPATION IN MEDICARE, MEDICAID, OR ANY OTHER FEDERAL HEALTH CARE PROGRAM?
*
YES
NO
IF ANSWERED YES, PLEASE EXPLAIN
Your answer
WHAT IS YOUR COMPUTER EXPERIENCE?( SELECT ALL THAT APPLY)
*
I am able to draft an e-mail
I can attach a photo or document to an e-mail
I have searched for information online
I have used word processing programs ( i.e. Google Docs, Microsoft Word)
I have created/used a Spreadsheet ( i.e. Google Sheets, Microsoft Excel)
I have used an online calendar
I can use a smartphone/tablet
I know how to send a text
I have used Voice to Text features
I know how to take/send pictures on a smartphone or tablet
I know how to Video chat (i.e. Facetime, Skype, SnapChat)
I have used a scanner
I have used Youtube
I have used Pinterest
I have used Social Media (Facebook, Instagram, Tiktok, etc.)
I have used an online documentation format i.e, Setworks, THERAP, etc.
Required
REFERRAL SOURCE:
*
Choose
Newspaper Advertisement
RISE Website
Employment Agency
RISE Facebook Page
Employee of RISE Ltd.
Online Job Search Engine
Friend
Other
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