Please read the following statements carefully, and acknowledge with your signature below. I understand and agree that:
1) Any material misstatement or deliberate omission of a relevant fact by me in this application, a resume, and/or attachments will be sufficient cause for terminating the consideration of my application or my subsequent employment.
2) The Arc of Rensselaer County may procure or have prepared an investigative report to verify any information affecting my employment including but not limited to a criminal background check, fingerprinting to meet OPWDD regulations for people who have regular and substantial unsupervised physical contact with consumers, a credit check and/or a driver's license check.
3) My employment with The Arc of Rensselaer County may be subject to satisfactory completion of a physical examination, which may include a drug and alcohol screening test, conducted at the direction of The Arc prior to my employment or at such time as may be required by The Arc of Rensselaer County.
4) Policy manuals, employee handbooks, and statements of employee benefits are informational only and do not create an employment contract or alter my status as an at-will employee, and no employee or representative of The Arc of Rensselaer County, other than an officer of The Arc, has authority to enter into any agreement which alters my status as an at-will employee.
5) If I am employed by The Arc of Rensselaer County, my employment and compensation may be terminated at any time at the option of either Arc or myself, with or without cause, and with or without notice.
6) If I am employed by The Arc of Rensselaer County, I will abide by The Arc’s policies and procedures.
7) If my application for employment or my employment is subject to a local ordinance, state statute or law that supersedes any provision of the application form, that that ordinance, statute or law will apply.
8) I authorize the institutions and individuals listed on this application to give The Arc of Rensselaer County any and all information they may have, personal or otherwise, concerning my previous character, and I release all parties from any liability that may result from furnishing such information to The Arc.
EOE
Equal Employment Opportunity
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.
The Information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.
Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
Gender
Male
Female
I choose not to disclose this information
Ethnicity
Hispanic or Latino (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race)
Not Hispanic or Latino (if not Hispanic or Latino, please address race below)
I choose not to disclose this information
Race (do not respond if you selected "Hispanic or Latino" above)
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, the Middle East, or North Africa
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment
Black or African American (Not Hispanic or Latino)
A person having origins in any of the black racial groups of Africa
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above five races
I choose not to disclose this information
Protected Veterans
The definitions of protected veterans are listed below. Use the boxes following the definitions to indicate whether you are a protected veteran
Disabled Veteran
A "disabled veteran" is one of the following:
Recently Separated Veteran
A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
Active Duty Wartime or Campaign Badge Veteran
An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
Armed Forces Service Medal Veteran
An "armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
I am not a Protected Veteran
I choose not to disclose this information
Disability Status
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.
Yes I have a disability (or previously had one)
No I don't have a disability
