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Job Application

Personal Information

Please let us know your name.
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Please let us know your email address.
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Employment History

Please provide all employment information for your past two employers starting with the most recent.

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References

List 3 references, including their names, telephone numbers, and years known (do not include Relatives or employers):


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Release

I hereby authorize the potential employer to contact, obtain and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references.

I understand that a background check may be conducted including the review of the following, Criminal Offender Record Information (C.O.R.I); any inquiry of this nature will occur only following those instances where a conditional offer of employment is made. I understand that foregoing will be verified, and I authorize the Bureau for Exceptional Children and Adults / Jericho or designee to conduct a background check.

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I understand that any intentional misrepresentation or material omission made by me on this application may constitute grounds for rescission of a job offer or immediate termination of employment if i am employed, without notice, whenever it may be discovered.

If I am employed, I understand that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

I understand that this is an alcohol and drug free workplace and consent to compliance with this policy as a condition of employment. I also understand that, if I am employed, I will be required to provide satisfactory proof within the identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment. I have read and fully understand the foregoing statements and I seek employment under these conditions.

WE ARE AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER
It is the policy of the Bureau for Exceptional Children and Adults / JERICHO to afford equal opportunity to all qualified persons regardless of race, color, religion, sex, national origin, age, military status, sexual orientation, sexual identity, handicap/disability, gender, gender identity, ancestry, genetic information, or any other class protected by federal or state anti-discrimination law (except where age or sex is a bona fide occupational qualification as allowed by the Civil Rights Act of 1964). The Bureau for Exceptional Children and Adults / JERICHO is committed to and promotes equal opportunity, affirmative action and diversity.

I certify, by checking the box and entering my name below, that I have signed this document.

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