(518) 810-8535

Employment Application

Creative Living Solutions Inc. (CLS Inc.) is an Equal Opportunity Employer. Applicants are considered for all positions (and treated during any subsequent employment), without regard to race, color, religion, gender, national origin, age, disability, sexual orientation, gender identity or expression, marital status, military status, domestic violence victim status, or any other prohibited basis of discrimination, as provided under applicable state and federal law.

Fill out the form below to apply, fields marked with an asterisk (*) are required.

Position Information

Personal Information

Employment Information

* Are you prevented from lawfully becoming employed in this country?
(Proof of citizenship or immigration status will be required upon employment)
* Have you ever been employed by our organization before?
* Have you EVER been convicted of a misdemeanor, felony, or other crime (other than a minor traffic infraction) in any jurisdiction?
(A conviction is not an automatic bar from employment. Each case is considered and evaluated on its individual merits in relation to the duties and responsibilities of the position)
* Are there any pending criminal charges against you?
* Have you EVER been sanctioned or otherwise disciplined by, or excluded from, the New York Medicaid Program, Medicare or any other state or federal government funded program?
* Have you had a personal or employment related conviction or prior history of child abuse, neglect or mistreatment?
* Have you EVER been convicted of a motor vehicle moving violation including but not limited to alcohol and drug related offences, or had any suspension, revocation, or occurrence (accidents) involving harm to human beings or property while driving?
(Please be advised that you may need to provide information, statements and fingerprints according to the requirements of the Agency, and OPWDD in order for a background check to be conducted through DCJS. If applicable, you will have the right to obtain, review and seek correction of any information received in response to tile criminal background check conducted by DCJS.)

Education

High School

* Did you graduate?
* What did you receive?

College/University

* Did you graduate?
* Degree:

Graduate/Professional

* Did you graduate?
* Degree:

Employment Experience

Company 1

May we contact your previous supervisor for a reference?
(This may be required prior to any employment offer)

Company 2

May we contact your previous supervisor for a reference?
(This may be required prior to any employment offer)

Company 3

May we contact your previous supervisor for a reference?
(This may be required prior to any employment offer)

Other Related History/Experience

Please list below the name address phone number and dates of any prior or current experience as an employee volunteer or provider with the New York State Office for People With Developmental Disabilities ("OPWDD"), any other state agency or any other human services provider. Also list any prior or current experience you have in work relevant to the position for which you are applying, including child caring experience. Employment listed above under Employment History need not be repeated. if you need additional space, please continue on a separate sheet of paper.

Company 1

May we contact your previous supervisor for a reference?
(This may be required prior to any employment offer)

Company 2

May we contact your previous supervisor for a reference?
(This may be required prior to any employment offer)

Company 3

May we contact your previous supervisor for a reference?
(This may be required prior to any employment offer)

References

Please list three (3) Personal References who are not related to you, and who are not previous employers.

Reference 1

Reference 2

Reference 3

Applicant's Statement

I certify that the information I provided on this application and any accompanying documentation. and will provide throughout the hiring process is true and complete to the best of my knowledge. The company may investigate all statements contained in this application and may utilize social media searches to do so. In the event of employment, I understand that false, incomplete or misleading information given in my application, during the interview(s) or at any other time, is grounds for and may result in immediate discharge regardless of the timing or circumstances of discovery. I further understand that should an offer of employment be extended, that employment will be "at will", for no specified duration and may be terminated by myself or CLS Inc. at any time, with or without cause. I understand that neither this application, any statements made by any CLS Inc. representatives, nor any offer of employment from CLS Inc. constitutes an employment contract. I also understand that no representative of CLS Inc. has the authority to enter into an employment contract, guarantee employment for a specified period, or modify any of the foregoing, other than in a written document signed by the Executive Director. I understand, also, that I am required to abide by all rules, policies and procedures, and regulations of the employer, and that any employment offer may be contingent on acceptable references, physicals, testing, and criminal background checks.