Employment Application | UCP of Greater Dane County

By checking this box, I certify that I am at least 18 years old, am authorized to work in the United States, and understand that employment is contingent upon passing a background check.

APPLICANT INFORMATION:

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Authorization to text *

Yes, I give UCP permission to text me regarding my application and next steps in the hiring process.
No, please do not text me.

Email *

Are there other names under which you have worked or attended school? *

Yes
No

If yes, please list for reference checking purposes:

EMPLOYMENT OBJECTIVE:

Position Desired: *

Inclusion Facilitator
Respite Provider
Support Specialist
No Preference

Are you applying to work with a specific person?

No
Yes

Who?

What is your relationship?

Are you interested in working with additional families?

Yes
No

AVAILABILITY:

UCP has shifts available 24 hours a day, 7 days per week.

Please share information regarding your availability or preferred schedule:

How many hours do you want to work per week?

For positions where a vehicle is required:

I have access to a reliable vehicle.
I have a valid driver's license.
I prefer to be placed on the busline.

(Please check all that apply.)

REFERENCES:

Please list supervisory references or individuals familiar with your job qualifications (Please do not list relatives or friends.)

Reference 1:

Name and Relationship:

Organization:

Email:

Phone:

Reference 2:

Name and Relationship:

Organization:

Email:

Phone:

Reference 3:

Name and Relationship:

Organization:

Email:

Phone:

Please list any experiences, training, or education which you feel is relevant to becoming an Inclusion Facilitator or Respite Provider. This may include personal experiences supporting people with disabilities, course work, other languages, licenses, certifications, volunteer work, civic duty, etc.

Would you like to attach your resume?

Yes
No

Add Your Resume (Optional)

We’d love to learn more about your background!Upload your resume (PDF or Word file), max size 5MB.

All information contained in this application is true and complete to the best of my knowledge and belief. I understand that misrepresentations or omissions of any kind may result in denial of employment or be cause for subsequent dismissal if I am hired. I authorize investigation of all statements in this application and contact of any or all of my former employers or any individuals familiar with me or my employment background for the purpose of verifying any information I have provided and/or for the purpose of obtaining any information, whether favorable or unfavorable, about me or my employment. I voluntarily and knowingly fully release and hold harmless any person or organization that provides information pertaining to me or my employment. Regardless of whether or not I become employed by the organization, I recognize that this application is not and should not be considered a contract of employment. I understand that employment at the organization is on an at-will basis and that my employment may be terminated with or without cause, and without notice, at any time, at my option or the organization's, unless specifically provided otherwise in a written employment contract. I further understand that no organization employee or representative has the authority to enter into a contract regarding duration or terms and conditions of employment other than an officer or official of the organization *

I agree.