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Reach for Independence Application for Employment

Thanks for your interest in joining the Reach team!

General Information

Name(Required)

First Last

Phone(Required)

Email(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

How long have you lived at this address?

Are you 18 years of age or older?(Required)

Yes

No

Do you have a valid driver license?(Required)

Yes

No

License #

State Issued

Expiration Date

Position Applying For?(Required)

Can you physically and mentally perform the duties of the job as described in the job description with or without accommodation?(Required)

Yes

No

Are you related to any Reach participant?(Required)

Yes

No

Please provide name and relation

Do you live at the same residence as any Reach participant?(Required)

Yes

No

Please provide name and address

Have you ever been convicted of a crime? (does not necessarily disqualify you from the job)(Required)

Yes

No

Please Explain (if applicable)

Have you ever been required by any licensing board or professional ethics body to surrender your license?(Required)

Yes

No

Please Explain(Required)

Have you ever been found guilty of professional ethics code violations or professional misconduct?(Required)

Yes

No

Please Explain(Required)

Have you ever been administratively determined to have committed abuse or neglect against an individual with disabilities?(Required)

Yes

No

Please Explain(Required)

Have you even been employed by this organization before?(Required)

Yes

No

Please Explain(Required)

Do you know anyone who currently works for Reach?(Required)

Yes

No

Please Provide Name(Required)

Do you have experience living with a person with an intellectual or developmental disability?

Yes

No

Note: lived experience may substitute for employment experience only for Supported Employment staff and a letter confirming that lived experience from a knowledgeable individual (not applicant) is required.

Please Explain

Education

High School Attended(Required)

City / State(Required)

Year of Graduation(Required)

Do you have any other higher education?(Required)

Yes

No

Please List

Work Experience

Most Recent Employer(Required)

Job Title(Required)

City / State(Required)

Dates Employed(Required)

Reason for Leaving(Required)

Phone Number(Required)

Email of Supervisor

Would you like to share additional work experience?(Required)

Yes

No

Please list additional work experience below

Military Service

Have you ever served, or are you currently serving in the Military?

Yes

No

Branch

Rank at discharge if no longer serving

Type of discharge

If other than honorable, please explain

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information within my application or interview may result in my release.(Required)

Yes

Electronic Signature (please type full name)(Required)

CAPTCHA

Comments

This field is for validation purposes and should be left unchanged.

Enrichment Center

410 Mills Gap Rd.
Fletcher, NC 28732

Administrative Office

11 Hooper’s Creek.
Fletcher, NC 28732

Business Hours

Monday – Friday:
8:30am – 3:00pm

Sat & Sun: Closed

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