Employment Application
SKILLS, Inc., is an equal opportunity employer and prohibits discrimination against otherwise qualifies applicants on the basis of the individual's status in a protected class. Protected classes include race, color, religion, sex, age, national origin, genetic information, legally recognized disability, military services or veteran status, creed, gender identity, sexual orientation, pregnancy, marital or civil union status, citizenship, ancestry, ethnic heritage, or any other status protected under local, state, or federal laws.
Email address *
PERSONAL
Date *
MM
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Last *
Your answer
First *
Your answer
Middle
Your answer
Phone Number *
Your answer
Physical Address *
Your answer
Mailing Address if different
Your answer
Position Sought *
Your answer
Desired Employment *
How did you hear of this position *
Your answer
Date Available *
MM
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DD
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YYYY
Hourly Wage Desired
Your answer
Are you 18 years or older *
If not, can you supply a work permit
Are you legally eligible for employment in the United States (if offered employment, you will be requires to provide documentation to verify eligibility
Please indicate if you have resided in any other state(s) or country(s)
Your answer
Do you have dependable transportation
A valid Driver's license *
How many hours a week are you seeking?
Your answer
What shift can you work (check all that apply
What days can you work (check all that apply) *
Required
Will you work overtime if asked? *
EDUCATION
Please indicate education or training which you believe qualifies you for the position you are seeking High School-Number of years completed (Check one)
Diploma? *
G.E.D?
Name of School
Your answer
City/State *
Your answer
College and/or Vocational School-Number of years completed
Name of School
Your answer
City/State
Your answer
Major
Your answer
Degree(s) Earned
Your answer
Other Special Training (i.e., CRMA, CPR/First Aid, DSP) Course
Your answer
Degree/Certificate Earned
Your answer
Course
Your answer
Degree/Certificate Earned
Your answer
Other Skills
Your answer
PROFESSIONAL LICENSE OR MEMBERSHIP Type of License(s) held
Your answer
License Number
Your answer
Expiration Date
MM
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DD
/
YYYY
Other professional membership(s)
(Please do not disclose membership or affiliations that are not specific to your profession and/or which may reveal protected status information)
Your answer
RECORD OF CONVICTION
(A conviction will not necessarily automatically disqualify you for employment. Rather, such factors as age and date of conviction, seriousness and nature of the crime and rehabilitation will be considered.)

Have you ever been convicted of:
Felony? *
Misdemeanor? *
Substantiation of abuse/neglect/exploitation of a child or adult? *
Assault? *
OUI? *
If you answered YES to any charge, please explain:
Your answer
If you have any pending charges, please explain:
Your answer
Have you ever been employed in any facility of SKILLS, Inc., including Ken-A-Set Assoc. or Sebasticook Farms?
If yes, please describe
Your answer
May we contact you present employer? *
EMPLOYMENT (List most recent employer first, including U.S. Military service
Employer
Your answer
Address
Your answer
Telephone
Your answer
Position
Your answer
Dates of employment: From-To
Your answer
Supervisor
Your answer
Department
Your answer
Duties
Your answer
Amount of average hours
Your answer
Reason for Leaving
Your answer
Employer
Your answer
Address
Your answer
Telephone
Your answer
Position
Your answer
Date of Employment: From-To
Your answer
Supervisor
Your answer
Department
Your answer
Duties
Your answer
Average amount of hours
Your answer
Reason for Leaving
Your answer
Employer
Your answer
Address
Your answer
Telephone
Your answer
Position
Your answer
Dates of Employment: From-To
Your answer
Supervisor
Your answer
Department
Your answer
Duties
Your answer
Average amount of hours
Your answer
Reason for Leaving
Your answer
If you wish to describe additional work experience, please include the above information for each position on a separate sheet of paper.
Explain any gaps in work history
Your answer
REFERENCES
(Please provide (2) Professional and (2) Personal (non-relative or employer) References)
Professional
Name
Your answer
Address
Your answer
Telephone
Your answer
Name
Your answer
Address
Your answer
Telephone
Your answer
Personal (non-relative or employer)
Name
Your answer
Address
Your answer
Telephone
Your answer
Name
Your answer
Address
Your answer
Telephone
Your answer
Applicant Certification
The information provided by me in this Application for Employment is true, correct, and complete. If employed, I understand that any untrue, misleading, misstatement or omission of fact on this Application or during the hiring process may result in my dismissal. *
I understand that receipt of this Application does not imply that I will be employed. If employed, I understand and agree that such employment will not be governed by any expressed or implied contract, but is at-will. I understand and agree that no representative of SKILLS, Inc., has the authority to make any assurance to the contrary. Either SKILLS, Inc., or I may terminate the employment relationship at any time, with or without notice for any lawful reason. *
I authorize SKILLS, Inc., to communicate with my prior and current employers, school officials, government agencies, and persons named as references concerning my employment performance and history, and my skills, character and responsibility. I hereby release and hold harmless all parties involved from any/all liability for any damage whatsoever resulting from giving information such as work performance, character, and reputation. I further understand that if I do not give permission to contact my current employer, my application may be automatically rejected. *
I understand that if offered a position with SKILLS, Inc., I will be required to submit to a pre-employment background check which may include a criminal background check, child/adult protective services background check, sexual predator history check, driver’s license check, medical examination, and any other checks required by laws, regulations, contracts, etc. I understand that these checks may be re-run at the discretion of SKILLS, Inc., throughout the term of my employment. I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these requirements will result in withdrawal of any employment offer or termination of employment. *
I understand that should an employment offer be extended to me and accepted, I will fully adhere to the policies, procedures, rules and regulations of employment of SKILLS, Inc. I understand specifically that mandatory trainings, attendance and punctuality are essential requirements of my job and non-compliance may result in disciplinary action up to and including termination. *
Type your full name to indicate agreement with the above terms and to electronically sign this employment application *
Your answer
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