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Employment Application
It is the policy of The Option Institute to consider all applications without regard to race, creed, color, religion, sex, sexual orientation, marital status, national origin, age, disability, Vietnam era or other veteran status, being a member of the Reserves or National Guard or the results of any genetic testing.

Personal Information
Position applying for:
*(Last) *(First) (MI)
*Address:
City: State: Zip:
*Home Phone Number
Business Phone Number
E-Mail
Are you over the age of 18? Yes No
If no please state your Date of birth:
Date Available: Days/Hrs Preferred: Salary Requirements:
Referred By:
If Other explain:
Are you eligible for employment in the United States? Yes No
Has any time restriction been placed on your eligibility for employment in the U.S? Yes No
If Yes, What restrictions?

NOTE: If hired, you are required by law to submit proof of identity and eligibility to work in the U.S
Have you ever been hired by The Option Institute? Yes No
If yes give date(s) and position:
Do you have any friends or relatives employed by The Option Institute? Yes No
If yes, give name(s)/relationship(s):
Are you capable of performing the essential functions of the job for which you are applying with reasonable accommodation?   Yes No
If no, please describe:
Have you ever been convicted of a Felony? Yes No
If yes, please describe in detail:

NOTE: Disclosure of a criminal record will not necessarily disqualify you from employment, as the nature of the offense, date and the position for which you are applying will also be considered.

Employment Record
Please list date of all employment starting with your most recent position. Attach a sheet of paper if necessary.
Most Recent Employer
Company
Name
Address
City State Zip
Position Held
Duties
Supervisor  
Title
Phone #
Dates Employed
From To
Salary
Start End
Reason for Leaving
Employer
Company Name
Address
City State Zip
Position Held
Duties
Supervisor  
Title
Phone #
Dates Employed
From To
Salary
Start End
Reason for Leaving
Employer
Company Name
Address
City State Zip
Position Held
Duties
Supervisor  
Title
Phone #
Dates Employed
From To
Salary
Start End
Reason for Leaving
Attach a Resume

Education & Skills
Name and Address of School Attended Dates Attended Did you Graduate? Type of Diploma Major/Minor Fields of Study
From To
High School
College/University
College/University
Graduate School
Other
List any honors or scholarships received:
List professional, trade, business or civic activities and offices held. (You may exclude memberships, which would reveal race, creed, color, religion, sex, sexual orientation, marital status, national origin, age, disability, Vietnam era or other veteran status, being a member of the Reserves or National Guard or the results of any genetic testing)
What specific skills do you possess that meet the particular needs of the position for which you are applying?

Military Service
Have you ever served in the U.S. Armed Forces? Yes No
From: To:
List special skills/abilities acquired:

Volunteering
Please list any volunteering you have done that you would like us to consider. Please exclude organization names which indicate race, creed, color, religion, sex, sexual orientation, marital status, national origin, age, disability, Vietnam era or other veteran status, being a member of the Reserves or National Guard or the results of any genetic testing.

References
List (with address and phone number the names of three persons familiar with your character, ability or education for more than one year. Please do not include friends or relatives)
  Reference 1 Reference 2 Reference 3
Name
Address
City
State
Zip
Phone
Time Known

Applicant’s Acknowledgment

I certify that the answers given by me to the foregoing statements and questions are true and correct and I authorize investigation of all statements contained herein. Further, I understand that misstatements of any information or omissions of significant facts in written application forms or in the interview may be grounds for discharge.

I hereby give Alternatives the right to make a thorough investigation of my past employment, education, and activities and I release from all liability all persons, companies, and corporations supplying such information. I indemnify Alternatives against any liability, which might result from making such investigation. I understand that any false answers or misleading information or implications made by me in this application or other required documents shall be considered sufficient cause for denial of employment or discharge.

Additionally, I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between Alternatives and myself for either employment or for the providing of any benefit. If an employment relationship is established, I understand that I have the right to terminate my employment at any time and that Alternatives retains a similar right.

If you do not understand any information given or questions asked in this application, please ask for an explanation.
I agree

Date

For more information, please don’t hesitate in contacting us.

Email
HR@option.org

Address
The Option Institute
Attn: Human Resources
2080 S Undermountain Road
Sheffield, MA 01257, USA

Fax
Attn: Human Resources
413-229-3202
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2080 S. Undermountain Road, Sheffield, MA USA 01257