[South Central Los Angeles Regional Center] HR Application for Employment

Electronic Application for Employment

This application will take about 20-30 minutes to complete. Please be sure to have a stable internet connection on your device. You will be required to submit typical information for a job application such as: name, address, educational and employment history, references, etc. You'll also be able to upload your resume in PDF or Word format.

If you'd like to submit an application for employment via Fax or Email instead click here to download PDF application. Then proceed to print, fill out, and Fax to 213-744-8457, or email to jobs@sclarc.org

Equal Opportunity Employer

South Central Los Angeles Regional Center is an Equal Employment Opportunity/Affirmative Action Employer. We adhere to a policy of making all employment decisions without regard to genetic information or characteristics, race, color, sex, gender, religion, national origin, age, disability, veteran status, sexual orientation, citizenship or any other protected classification, which may be applicable under the law of the particular state or locality in which you are applying for employment with the Company.

If you're ready to continue with this electronic application at this time, mark this checkbox, then click Next

SCLARC

South Central Los Angeles

Regional Center

for Persons with Developmental Disabilities, Inc.

Referral Source: How did you hear about us?

Specify employee name

Specify

Desired Employment

Position(s) applied for

Date available for work

Desired Salary

Personal Information

Name

Primary Phone Number

Alternate Phone Number

E-mail address

Type of Employment Desired

Full-time

Part-time

Temporary

Are you on lay-off status and subject to recall?

Yes

Have you filed an application at SCLARC before?

Yes

When did you file an application for employment at SCLARC?

Have you ever been employed at SCLARC before?

Yes

When did you work at SCLARC?

Will you work overtime if required?

Yes

Will you travel if the job requires it

Yes

Driver's License Number and state (if job-related)

Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?

Yes

Describe functions that cannot be performed

If you are under 18, can you furnish a work permit?

Yes

Can you, after employment, submit verification of your legal right to work in the United States? (Proof of United States citizenship or immigration status will be required upon employment.)

Yes

EMPLOYMENT HISTORY

List last four employers, assignments or volunteer activities, starting with the most recent, including military experience.

Employer Name (1)

Employer Phone Number (1)

Dates Employed (1)

Job Title (1)

Employer (1) Address, City, State

Immediate supervisor and title (1)

May we contact for reference? (1)

Reason for leaving (1)

Summarize the nature of the work performed and job responsibilities (1)

Employer Name (2)

Employer Phone Number (2)

Dates Employed (2)

Job Title (2)

Employer (2) Address, City, State

Immediate supervisor and title (2)

May we contact for reference? (2)

Reason for leaving (2)

Summarize the nature of the work performed and job responsibilities (2)

Employer Name (3)

Employer Phone Number (3)

Dates Employed (3)

Job Title (3)

Employer (3) Address, City, State

Immediate supervisor and title (3)

May we contact for reference? (3)

Reason for leaving (3)

Summarize the nature of the work performed and job responsibilities (3)

Employer Name (4)

Employer Phone Number (4)

Dates Employed (4)

Job Title (4)

Employer (4) Address, City, State

Immediate supervisor and title (4)

May we contact for reference? (4)

Reason for leaving (4)

Summarize the nature of the work performed and job responsibilities (4)

EDUCATIONAL BACKGROUND

Please select all that apply, and provide information below

High School

Undergraduate School

Graduate School

Post Graduate School

Other

High School Name and Address/City/State (HS)

Month/Year Graduated (HS)

Years completed (HS)

Degree/Diploma (HS)

Course of Study (HS)

____________________________________________________

Undergraduate School Name and Address/City/State

Month/Year Graduated (Undergraduate )

Years completed (Undergraduate)

Degree/Diploma (Undergraduate)

Course of Study (Undergraduate)

____________________________________________________

Graduate School Name and Address/City/State

Month/Year Graduated (GradSchool)

Years completed (GradSchool)

Degree/Diploma (GradSchool)

Course of Study (GradSchool)

____________________________________________________

Post Graduate School Name and Address/City/State

Month/Year Graduated (Post Grad)

Years completed (Post Grad)

Degree/Diploma (Post Grad)

Course of Study (Post Grad)

____________________________________________________

Other (Specify) School Name and Address/City/State

Month/Year Graduated (Other Ed)

Years completed (Other Ed)

Degree/Diploma (Other Ed)

Course of Study (Other Ed)

____________________________________________________

Do you speak/read/write any foreign language(s)?

Yes

Specify Language 1

Language 1 (Check all that apply)

Speak Some

Speak Fluently

Read

Write

Specify Language 2

Language 2 (Check all that apply)

Speak Some

Speak Fluently

Read

Write

Specify Language 3

Language 3 (Check all that apply)

Speak Some

Speak Fluently

Read

Write

REFERENCES

List name and telephone numbers of three business/work references who are not related to you.

Name and Address/City/State (Reference 1)

Telephone Number (Reference 1)

Years Known (Reference 1)

Name and Address/City/State (Reference 2)

Telephone Number (Reference 2)

Years Known (Reference 2)

Name and Address/City/State (Reference 3)

Telephone Number (Reference 3)

Years Known (Reference 3)

List professional, trade, business or civic associations and any offices held. (Exclude memberships which would reveal sex, race, religion, national origin, age, color, disability or other protected categories.)

List any additional skills, training, special accomplishments or anything that you would like us to consider.

Place a check mark by any office machinery that you are able to operate.

Typewriter

10-key

Shorthand/Speedwriting

Computer

Other Office Equipment

Typewriter Words Per Minute (WPM)

10-Key Speed (KPH)

Shorthand/Speedwriting Words Per Minute (WPM)

What software programs can you use?

Specify Other Office Equipment

Upload Resume (not required to submit application)

Click Here to Upload

PLEASE READ CAREFULLY BEFORE SIGNING

A clear understanding of your background and work history will aid us in placing you in the position that best meets your qualifications. Please make sure that you have completed each section of the job application. Failure to complete and/or sign the application will result in the application not being checked or considered further. This application will remain active for a period of 30 days after the date of application.

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed regardless of the time elapsed before discovery.

I hereby authorize the Company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the Company any and all letters, reports and other information related to my work records without giving me prior notice to such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I understand that nothing contained in the application or conveyed during any interview, which may be granted or during my employment, if hired, is intended to create an employment contract between me and the Company. In addition, I understand and agree that if I am employed, my employment is at-will and is for no definite or determinable period and may be terminated at any time, with or without notice or with or without cause, at the option of either myself or the Company. No promises or representations contrary to the foregoing are binding on the Company unless made in writing and signed by me and the Company's designated representative.

I have read and agree with the statement above.

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and submit this application and any attachments included.