Community Interactions Inc.

COMMUNITY INTERACTIONS, INC.

It is the policy of Community Interactions, Inc. to be an Equal Opportunity Employer. We consider applicants for all positions without regards to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status. Community Interactions, Inc. is a drug free workplace and conducts random drug screening for all employees.

Please complete this application in it's entirety.

Date of Application

Full Name

Street Address

City

State

Zip

Home Telephone Number
Please enter in the following format (xxx) xxx-xxxx

Email Address (required)

Are you between the ages of 18 and 20?
YesNo

Are you 21 years of age or older?
YesNo

Have you been a Pennsylvania resident for the last 2 consecutive years?
YesNo

How did you learn about Community Interactions?

Position Applying For
---Direct Support Professional (DSP)Team Facilitator-Southeastern PAProgram Coordinator-Southeastern PAPA Day Services Administrative Assistant

Preferred Program
---Day Program ServicesResidential ServicesNo preference

Date Available to start

Are you interested in
Check all that apply
Per-DiemFull-TimePart-Time

Preferred Shift
DayAfternoon/EveningOvernightWeekends

Have you ever been employed by Community Interactions Inc.?
YesNo

If so, when did you leave?

Do you currently possess a valid Driver's License?
YesNo

Some programs may require use of a personal vehicle. Would you consider using your personal vehicle? Answering No does not preclude you from employment from CI.
YesNo

Have you ever been convicted of a criminal or federal offense?
YesNo

If you answered yes, please explain
A conviction will not automatically bar you from employment with Community Interactions Inc.

Select your education level
---High School or GEDTrade SchoolSome College/Technical SchoolCollege/Trade School GraduatePost College

Current or Most Recent Employer
Please include employer name, address, and telephone number

Dates of Employment

Salary

Brief Description of job duties

May we contact this employer?
YesNo

Previous Employer
Please include employer name, address, and telephone number

Dates of Employment

Salary

Brief Description of job duties

May we contact this employer?
YesNo

Personal Reference (required)
Please list the name of someone who is not related to you.