Alternative Services for Individuals LLC. - Alternative Services for Individuals assists individuals with developmental disabilities to reach their full potential by giving them the opportunity to become productive members of society.
 
ALTERNATIVE SERVICES FOR INDIVIDUALS APPLICATION
Position Applying For:
Last Name:
First Name:
Middle Name:
MAILING ADDRESS:
House / Apt No.
Street
City
Postal Code
PERMANENT ADDRESS
(If Different from Above Address)
TELEPHONE:
Home:
Business
Fax
Are you legally entitled to work in USA
Yes
No
As an adult, have you ever been convicted of an offense other than a traffic violation?
Yes
No
Are you able to work any shift ?
Yes
No
Do you have any relatives working with this agency ?
Yes
No
If yes, name(s):
EDUCATION AND TRAINING
High School /GED
Name & location of institution
Number of years completed
Field of Study
Grade/Diploma/Degree and year completed
Commercial, Trade or Technical Training
Name & location of institution
Number of years completed
Field of Study
Grade/Diploma/Degree and year completed
Undergraduate College/University
Name & location of institution
Number of years completed
Field of Study
Grade/Diploma/Degree and year completed
Graduate/ Professional
Name & location of institution
Number of years completed
Field of Study
Grade/Diploma/Degree and year completed
Other Continuing Education
Name & location of institution
Number of years completed
Field of Study
Grade/Diploma/Degree and year compleated
Professional Qualifications/ Memberships/Licenses if applicable:
SECRETARIAL/CLERICAL SKILLS:
Word processing Software
Spreadsheet Software
Database Software
Keyboarding
Dictaphone
Data Entry
Graphics
Special Terminolgy
If the keyboarding box was checked above, please indicate the nwpm
Other(Specify)
COMPUTER SKILLS:
IBM
Mac
VAX / VMS
Please specify computer systems you have worked with, courses you have taken and your working knowledge of computer software:
TECHNICAL SKILLS:
TRADES/MAINTENCE SKILLS:
LANGUAGE SKILLS: Spoken and Written
If you are applying for a position requiring a driver's license, please complete the following: Do you have a valid driver's license?
Yes
No
Previous Employment (begin with most recent) Name of Employer:
Address:
Last Position Held:
Phone:
Name of Supervisor:
Reason for Leaving:
Employment From:
To:
Final Salary:
Duties:
Name of Employer
Address:
Last Position Held:
Phone:
Name of Supervisor:
Reason for Leaving:
Period Employed
Final Salary:
Duties:
Name of Employer:
Address:
Last Position Held:
Phone:
Name of Supervisor:
Reason for Leaving:
Period Employed:
Final Salary:
Duties:
List three pers, other than relatives or personal friends, who can judge your work ability. Name, Company, Position, and Telephone #
May we contact your present employer for a reference?
Yes
No
Previous employer?
Yes
No
 
 
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