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Our Agency
SERRC Employment Application
Position
>>
Contact
>>
Education
>>
Employment
>>
References
>>
Additional
>>
Submission
Welcome to the SERRC employment applications. Please complete all required fields below.
Position Details
Position Applying For:
- None -
Speech Therapist
Physical Therapist
Occupational Therapist
Special Education Specialist
Computer Instructor (Part-time)
Family Learning Center Instructor
After School Club Paraprofessional
Position Applying For (If Not Above):
Position Location:
- None -
Juneau
Anchorage
Other
If other, describe:
How did you hear of this position?:
- None -
Website
Word of Mouth
Direct Mailing
ATP
Advance
State Association
National Association
Other
If other, describe:
When can you start?:
Salary desired:
Have you ever applied with SERRC before?:
- None -
Yes
No
Are you familiar with the essential functions of the job?:
- None -
Yes
No
Are you legally authorized to work in the United States?:
- None -
Yes
No
Continue >>
Contact Information
First Name:
*
Middle Name:
Last Name:
*
Email Address:
*
Contact Phone:
*
Work Phone:
Physical Address
Street Address:
City:
*
State:
Zip Code:
Mailing Address
Street Address:
*
City:
State:
Zip Code:
*
Continue >>
High School
Do you have a high school diploma or GED certificate?:
- None -
Yes
No
High School Name:
High School Graduate?:
- None -
Yes
No
High School City and State:
College
College Graduate?:
- None -
Yes
No
College Name:
College City and State:
College Subjects Studied, Grades Received:
Trade, Business or Correspondence School
Trade School Graduate?:
- None -
No
Yes
Trade, Business or Correspondence School Name:
Trade, Business or Correspondence School Address:
Subjects Studied / Degree(s) Received:
Additional Education
Special Study / Research:
Special Interests / Certificates / Experiences:
Continue >>
Employer Contact
May we contact your present employer?:
- None -
Yes
No
May we contact your previous employers?:
- None -
Yes
No
Current/Most Recent Employment
Employer:
Position Title:
Reason for Leaving:
Employer Address:
Pay Rate:
Supervisor Name:
Phone:
Past Employer #1
Employer Name:
Position Title:
Reason For Leaving:
Employer Address:
Date Started:
Format: 07/30/2010
Date Left:
Format: 07/30/2010
Pay Rate:
Supervisor Name:
Phone:
Past Employer #2
Employer Name:
Position Title:
Reason For Leaving:
Employer Address:
Date Started:
Format: 07/30/2010
Date Left:
Format: 07/30/2010
Pay Rate:
Supervisor Name:
Phone:
Past Employer #3
Employer Name:
Position Title:
Reason For Leaving:
Employer Address:
Date Started:
Format: 07/30/2010
Date Left:
Format: 07/30/2010
Pay Rate:
Supervisor Name:
Phone:
Continue >>
Reference 1
Name:
Address:
Contact Phone:
Business Phone:
Relationship:
Reference 2
Name:
Address:
Contact Phone:
Business Phone:
Relationship:
Reference 3
Name:
Address:
Contact Phone:
Business Phone:
Relationship:
Continue >>
Convictions
Have you ever been convicted of a felony?:
- None -
Yes
No
Have you been convicted of a misdemeanor within the past 5 years?:
- None -
Yes
No
Are you currently under arrest or indictment for any violation of law?:
- None -
Yes
No
If the answer to any of the above is yes, please explain:
Resume Upload
Resume:
Maximum Filesize:
55 MB
Allowed Extensions:
txt pdf doc docx xls xlsx rtf odf
Continue >>
Application Agreement
I hereby certify that all information made on or in connection with this application is true and complete to the best of my knowledge and belief. I understand that any misrepresentation or concealment of material fact will be sufficient ground for rejection of my application or dismissal from employment. I authorize investigation of all statements made in this application, I understand and agree that my employment lasts for no definite period of time and may, regardless of the date of payment of my wages or salary, be terminated at any time without previous notice.
Application Agreement:
*
I Agree
I hereby certify that all information made on or in connection with this application is true and complete to the best of my knowledge and belief. I understand that any misrepresentation or concealment of material fact will be sufficient ground for rejection of my application or dismissal from employment. I authorize investigation of all statements made in this application, I understand and agree that my employment lasts for no definite period of time and may, regardless of the date of payment of my wages or salary, be terminated at any time without previous notice.
Authorization for Reference Checks
I hereby authorize my past employers and listed and non-listed references to release information to SERRC regarding my employment, provided the information is used solely to determine my suitability for employment with SERRC. I release SERRC from liability for relying in good faith on the information so provided. This release of information covers my employment record in general, information relating to my character, general reputation, and personal characteristics as those subjects bear on my suitability for employment, in addition to other information relating to my educational and work experience.
Reference Check:
*
I Agree
I hereby authorize my past employers and listed and non-listed references to release information to SERRC regarding my employment, provided the information is used solely to determine my suitability for employment with SERRC. I release SERRC from liability for relying in good faith on the information so provided. This release of information covers my employment record in general, information relating to my character, general reputation, and personal characteristics as those subjects bear on my suitability for employment, in addition to other information relating to my educational and work experience.
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