Volunteer Application : Contact : Favarh - The Arc of the Farmington Valley

I am applying for:

Please Select All that Apply

Employment
Volunteer Experience
Internship

Applicant Information

Full Name (Required)

Current Street Address (Required)

City (Required)

State (Required)

Zip Code (Required)

Phone Number (Required)

Please Fill in Number Below With Area Code

Email Address (Required)

Referred By

Please enter the name of the current Favarh staff member who referred you to the agency

Driver's License Number (Required)

State Issued (Required)

Do You Have a Public Service Operator License?

Do You Have Proof of Eligibility to Work in the United States?

Are You Over the Age of 18?

Employment Preferences and Information

Employment Status Desired

Please Select All that Apply

Full Time
Part Time
Substitute

Position Desired

Direct Support Professional
Administration
Management
Driver

Please Select ALL the Locations You are Willing to Travel

Canton
Avon
Farmington
Simsbury
Hartford
Bristol
Meriden
West Hartford
Granby

Earliest Start Date (Required)

Dates / Time You are Available to Work? (Required)

Pay Rate Desired (Required)

Are You Currently Employed?

If YES, May We Contact Your Current Employer?

Current Pay Rate? (Required)

(Required)

Please Fill in Salary Amount Below

Have you been employed by Favarh?

Have you ever previously applied to Favarh?

If YES, when did you apply and for what position(s)?

Applicant Education and Training

College / University

Name and Location

What was the last year you completed?

Did you Graduate?

Subjects Studied / Degree(s) Earned?

Trade, Business or Correspondence School

Name and Location

What was the last year you completed?

Did you Graduate?

Subjects Studied / Degree(s) Earned?

High School

Name / Location

What was the last year you completed?

Did you graduate?

Please list any relevant coursework / experiences

Do you have any or all of the following?

Medication Administration Certification

First Aid Certification

CPR Certified

First Aid / CPR Expiration Date:

Physical, Psychological Management Training (PMT)

PMT Expiration Date:

Other Trainings / Certifications:

Work Experience:

Please start with the most recent experience, including any volunteer or internship experiences

Employer Name / Address / Phone Number (Required)

Month (Required)

Year (Required)

Title / Duties (Required)

Reasons for Leaving / Pay Rate (Required)

Employer Name / Address / Phone Number

Month

Year

Title / Duties

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Reasons for Leaving / Pay Rate

Employer Name / Address / Phone Number

Month

Year

Title / Duties

Reasons for Leaving / Pay Rate

Employer Name / Address / Phone Number

Month

Year

Titles / Duties

Reasons for Leaving / Pay Rate

References

List names of three (3) persons, not related to you, who have Supervised your work.

Supervisor's Name (Required)

Phone Number (Required)

Company and Position (Required)

Years / Dates Acquainted (Required)

Supervisor's Name (Required)

Phone Number (Required)

Company and Position (Required)

Years / Dates Acquainted (Required)

Supervisor's Name (Required)

Phone Numbe (Required)

Company and Position (Required)

Years / Dates Acquainted (Required)

Physical Record

Note: Do not answer the following question unless you have been informed about the requirements of the job for which you are applying.

Do you have any physical condition that may limit your ability to perform the job for which you are applying?

Applicant Sign-Offs and Agreements

Applicant Assurance and At Will Employment Agreement

I certify that the answers given herein are true and complete. I authorize investigation of all statements contained in this application. I understand that misrepresentation/falsification or omission of facts is cause for termination. Furthermore, I understand and agree that if employed, my employment is at will and is not for a definite period and may, regardless of the date of payment of wages earned, be terminated at any time by my own will or the employer’s without any notice and or reason as outlined in The Arc of the Farmington Valley, Inc.’s Policies. I have fully read the job description and understand the responsibilities.

*Note Checking off the above box and filling in your Full Name and Date below, serves as your electronic signature.

Applicant Name: (Required)

Date: (Required)

Authorization for Release of Information

I, hereby authorize the release of information regarding employment history, criminal background, driving record, DDS neglect/registry and drug test results to The Arc of the Farmington Valley, Inc. Favarh.

*Note Checking off the above box and filling in your Full Name and Date below, serves as your electronic signature.

Applicant Name: (Required)

Date: (Required)

Favarh Drug Test Policy Acknowledgment

The Arc of the Farmington Valley, Inc. (Favarh) requires successful completion of a urinalysis drug test as part of its pre employment screening process for potential employees applying for safety-sensitive positions. Additionally, The Arc of the Farmington Valley, Inc. requires successful completion of a urinalysis drug test if The Arc of the Farmington Valley, Inc. has reasonable suspicion that the employee is under the influence of drugs or alcohol that adversely affects or could adversely affect the employee’s job performance. The Arc of the Farmington Valley, Inc. also requires employees in occupations that have been designated as safety-sensitive by the State of Connecticut to undergo random urinalysis drug testing. Drug tests are conducted for the Arc of the Farmington Valley, Inc. by an outside, professional laboratory. Further details will be provided to applicants who successfully meet The Arc of the Farmington Valley, Inc.’s other criteria for employment. Favarh is required to notify applicants of our intent to conduct urinalysis drug testing, we ask that you sign and date this notice indicating that you understand our policy.

*Note Checking off the above box and filling in your Full Name and Date below, serves as your electronic signature.

Applicant Name: (Required)

Date: (Required)

Reference Checking Consent & Authorization to Release Form

Read carefully and completely before signing.

Section I - Consent

I have applied for employment with The Arc of the Farmington Valley, also known as Favarh, and have provided information about my previous employment. My signature below authorizes my former or current employers and references to release the contents of my employment record with their organizations and to provide any additional information that may be necessary for my application for employment to The Arc of the Farmington Valley, whether the information is positive or negative.

I authorize The Arc of the Farmington Valley to investigate all statements made in my application for employment and to obtain any and all information concerning my former/current employment. I knowingly and voluntarily release all former and current employers, references, and The Arc of the Farmington Valley from any and all liability arising from their giving or receiving information about my employment history, my academic credentials or qualifications, and my suitability for employment with The Arc of the Farmington Valley.

This form may be photocopied or reproduced as a facsimile, and these copies will be as effective as a release or consent as the original which I sign.

Section ll: Signature (Required)

Full Name and Date below, serves as your electronic signature.

Date: (Required)

Have you ever taken the DDS Medication Test?

If YES, please explain below:

YES
NO - STOP HERE

Medication Administration Expiration Date

Have you ever been convicted of a crime involving the manufacture, sale, dispensing, possession, or possession with intent to sell any controlled substance?

Is your current Medication Certificate under review for possible suspension or revocation?

Has your Medication Certificate been suspended or revoked?

Thank You for your interest in Favarh, The Arc of the Farmington Valley, Inc.

Contact

Applicant Information

Employment Preferences and Information

Applicant Education and Training

Work Experience:

References

Physical Record

Applicant Sign-Offs and Agreements

Reference Checking Consent & Authorization to Release Form

Privacy Policy

Terms & Conditions

Donation Refund Policy

Automated Recurring Donation Cancellation