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203-754-6172

Find Us

135 East Liberty Street, Waterbury

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Careers

Discover the magic of our community. Be part of us.

Available Positions

Direct Care Worker

  • Hartford, CT
  • New Britain, CT
  • Waterbury, CT
  • Bristol, CT

Employment Application

APPLICANT INFORMATION

Max. file size: 2 GB.
Max. file size: 2 GB.
Name
Address
Are you a US citizen?
If no, are you authorized to work in the US?
Have you ever worked for this agency?

EDUCATION

High School Name
Address
Did you graduate?
College Name
Address
Did you graduate?

MILITARY SERVICE

Do you speak, read, or write a language other than English?

PREVIOUS EMPLOYMENT

Address
Address

REFERENCES (please list three (3) references)

Name
Address
Name
Address
Name
Address

AVAILABILITY

Days
Days

PERSONAL DISCLOSURE

Have you ever been convicted of a felony?

Special note: You are not required to disclose the existence of any arrest, criminal charge, conviction, or the records of which have been erased pursuant to Connecticut General Statutes, 46-b-146, 54-760 or 54-142a. If your criminal records have been pursuant to any of these statutes, you may swear under oath that you have never been arrested. Criminal records that may be erased are records pertaining to a finding of delinquency or that a child was a member of a family with service needs. (C.G.S. 46b-146), an in judication as a youthful offender (C.G.S., 54-760), a criminal charge that has been dismissed or mulled. A criminal for which the person has been found guilty or a conviction for which the person received an absolute pardon (C.G.S., 54-142a).

DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge. If this application leads to a volunteer opportunity, I understand that false or misleading information in my application or interview may result in my release.

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