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Cardinal Hayes Home for Children
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Employment Form
Cardinal Hayes Home for Children Application
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When can we contact the employers listed above?
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Immediately
Upon a conditional offer of employment
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(Do Not List Former Employers or Relatives - Teachers or Previous Co-workers preferred)
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Cardinal Hayes Home
Milbrook, NY
BACKGROUND SCREENINGS
Employment may require clearance through OPWDD’s Criminal Background Check Unit, SEL, MHL 16.34 Statewide Central Registry, and others as required by New York State OPWDD and the Justice Center. Convictions and/or allegations do not automatically disqualify your from employment. Failure to disclose information or misrepresentations will be considered falsification of this application.
Have you ever been the subject of an indicated case of child abuse and maltreatment or convicted of sexual misconduct in any state?
(Required)
Yes
No
If yes, please explain:
Have you ever been convicted of a misdemeanor or felony in any jurisdiction?
(Required)
Yes
No
If yes, please explain:
Do you have any criminal charges pending?
(Required)
Yes
No
If yes, please explain:
Have you been convicted of a moving violation within the last 3 years (including, but not limited to convictions involving alcohol and/or drugs while driving)?
(Required)
Yes
No
Has your license even been suspended or revoked?
(Required)
Yes
No
Have you been involved in a motor vehicle accident or occurrence involving harm to anyone or property while driving? (Please note harm to property can be as minor as hitting a guard rail or a street sign, another vehicle, minor accident, etc.)
(Required)
Yes
No
If yes, describe in full:
In a short paragraph, briefly tell us why you are interested in working with individuals with developmental disabilities.
PLEASE AGREE TO THE FOLLOWING TERMS
(Required)
The facts set forth in my application for employment are true and complete. I understand that if employed, false statements on this application shall be considered sufficient cause for dismissal. You are hereby authorized to make any investigation of my personal history, financial and credit record through any investigative or credit agencies or bureaus of your choice.
In making this application for employment, I authorize you to make an investigative consumer report whereby information is obtained through personal interviews with my neighbors, friends, or others with whom I am acquainted. This inquiry, if made, may include information as to my character, general reputation and personal characteristics.
I understand that my employment will be based upon the outcome of background checks, successful completion of the agency’s orientation process and all reference checks. I am considered a temporary/provisional employee until the above is satisfied.
I agree to the terms and conditions.
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