Application | vantagegroupinc

Application for Employment

Vantage Group requires drug screening prior to employment

First Name

Email Address

Last Name

Phone

Street Address

City

Position applying for

State, Zip

Referred by

Are you a citizen of the U.S.?

If no, are you authorized to work in the U.S.?

Have you previously worked at Vantage Group before?

If yes, please provide dates of employment

Names of friends / relatives employed by agency

Interested in:

Full Time

Part Time

Relief / Per Diem

EDUCATION

High School

Dates attended

Address

Did you graduate?

Degrees / Diploma:

College / University

Dates attended

Address

Did you graduate?

Degrees / Diplomas

Trade / Technical Training

Dates attended

Address

Did you graduate?

Degrees / Diploma

REFERENCES

(List 2 professional references who are not related to you, are familiar with the quality of your work / have worked directly with you and have known you at least 3 years)

1

Reference Name

Street Address

City

State, Zip

2

Reference Name

Street Address

City

State, Zip

PERSONAL DATA

Do you have a valid driver's license to operate a motor vehicle?

If yes, issuing state

License #:

Do you have any point / demerits against your license in the past three years?

Expiration Date:

If yes, explain points/demerits:

Have you been convicted of any motor vehicle violation; including suspension, revocation, DWI, convictions of occurences involving harm to a person or property in the past three years?

If yes, expain convictions:

What hours are you available to work? (Please be specific)

If hired by Vantage, would you work another job?

If yes, what would your schedule be?

TRAININGS/CERTIFICATIONS

(Please check off all that apply. If hired you must be able to provide proof of certification upon request.)

CPR

First Aid

Med Certification

PMT

Dysphasia

HIPPA

OSHA

Abuse & Neglect

Human Rights

Vital Signs

Signs & Symptoms

Seizures

Basic Health & Behavioral Overview

Fire Safety

Communicable Diseases

Infection Control

1 EMPLOYMENT HISTORY

(Begin with your most recent employer, if additional space is needed, add to comments section)

Past Employer

Phone Number

Address

Job Title

Manager's Name

Dates of Employment

May we contact your previous supervisor for a reference?

Job duties & responsibilities

Reason for leaving

2

Past Employer

Phone Number

Address

Job Title

Dates of employment

Manager's Name

May we contact your previous supervisor for a reference?

Job duties and responsibilities

Reason for leaving

PERSONAL STATEMENT

(Our mission is: "to support individuals of all ages with intellectual & developmental disabilities to live their fullest & most independent lives through housing, employment, education, social support & community participation.")

How will you help us achieve our mission?

Additional Comments:

DISCLAIMER AND SIGNATURE

The information provided in this Application for Employment is true, correct and complete.

If employed, any misstatement or omission of fact on this application may result in my dismissal.

All offers of employment are contingent upon receipt of good references and meeting all appropriate employment physical standards.

I understand that if hired, my employment may be terminated either by myself or by Vantage Group at any time for any reason, and that no employee at Vantage Group has any authority to make representations to the contrary.

I also acknowledge that my hours and/or shift assignments may be changed at the sole discretion of Vantage Group.

I agree that, if hired, I will abide by all the Policy and Procedures and Personnel Manual of Vantage Group. I understand that if I do not do so, I am subject to termination.

I understand that by signing this application Vantage Group, Inc. may contact my current or former employer to for a reference check. This information will not be used for any other purpose.

I agree to the application disclaimer

Your Signature

Today's Date

Additional Requirements

DISCLOSURE REGARDING CONSUMER REPORT BACKGROUND CHECK

Vantage Group (“The Company”) may obtain information about you from a third-party consumer reporting agency. Thus, you may be the subject of a “consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records (“driving records”).

You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you and to request a copy of your report. These searches will be conducted by IntelliCorp Records, Inc., 3000 Auburn Drive, Suite 410, Beachwood, Ohio 44122; Tel. No. 1.888.946.8355; www.intellicorp.net.

Last Name

First Name

Current Address

Date of Birth

Other names used (including maiden name)

MIddle Name

Dates lived here

SS Number

Driver's License #

Driver's License State

Email Address (may be used for official correspondence)

I certify that all elements of the personal data I have provided are true, accurate and complete

I have read and understand the Disclosure

and authorize Vantage Group, Inc. to obtain and

rely upon consumer reports or investigative consumer reports concerning myself obtained from IntelliCorp Records, LLC

Your Signature

Today's Date

DRUG TESTING - Pre-Employment Drug Testing Policy

Please read the Vantage Drug Testing Policy. By signing below you attest that you have read and understood this policy.

I attest that I have read and understand theDrug Testing Policy

Your Signature

Today's Date

AFFIRMATIVE ACTION DATA

Vantage Group, Inc. is an Equal Opportunity/Affirmative Action Employer. Applicants are considered for positions without regard to race, creed, color, religion, sex, national origin, sexual orientation, ancestry, age, marital, family or veteran status, past or present history of mental disorder, developmental disability, learning disability or physical disability.

Because Vantage Group, Inc. is committed to making a concerted effort to recruit qualified applicants from all of the above mentioned groups, we ask that you complete the following questions so that we may evaluate those efforts.

This information will be used solely for EEO reports, affirmative action and recruitment purposes, in accordance with the American with Disabilities Act (ADA) and other applicable laws. Submission of the following information is voluntary and refusal will not subject you to any adverse treatment. Although completing this form is voluntary, your cooperation will help us with mandated federal and state reporting requirements and with future recruitment efforts. As required by the ADA and other applicable laws, this data will be maintained in a confidential file separate to your application.

Position Applied For

Date

Sex

Date of Birth

Race/Ethnic Group

Check all that apply:

Veteran

Veteran with Disability

Indiv. with Disability

Since the data will not be used for recruitment or hiring purposes as stated above, stating the nature of disability will not be considered for purposed of requesting accommodation.

Please indicate below how you became aware of this job opportunity.

Newspaper

Radio

Job Posting

Employment Referral Service

Community/Civic Organization

State Job Line Service

College Placement Office

Informed by a friend

Informed by a Vantage employee

Other

Please indicate name of paper / station / agency / group / service / website / person from whom you learned of this opportunity

We are an equal opportunity employer, dedicated to a policy of nondiscrimination in employment on any basis including race, color, age, sex, religion, disability or national origin.

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Thank you for applying! Your application has been forwarded to the HR Department.

Application for Employment

Vantage Group requires drug screening prior to employment

EDUCATION

REFERENCES

1

2

PERSONAL DATA

TRAININGS/CERTIFICATIONS

1

EMPLOYMENT HISTORY

2

PERSONAL STATEMENT

DISCLAIMER AND SIGNATURE

​

I understand that if hired, my employment may be terminated either by myself or by Vantage Group at any time for any reason, and that no employee at Vantage Group has any authority to make representations to the contrary.

​

I also acknowledge that my hours and/or shift assignments may be changed at the sole discretion of Vantage Group.

​

I agree that, if hired, I will abide by all the Policy and Procedures and Personnel Manual of Vantage Group. I understand that if I do not do so, I am subject to termination.

​

I understand that by signing this application Vantage Group, Inc. may contact my current or former employer to for a reference check. This information will not be used for any other purpose.

Additional Requirements