Application for Employment/Volunteer

This Agency is an Equal Opportunity Employer. No question of this application is asked for the purpose of limiting or excluding any applicant’s consideration for employment because of his/her race, color, creed, religion, sex, age, national origin, military status, ancestry, disability, or sexual orientation.

Background and drug screenings will be completed on all applicants offered employment.

Click here for printable application.

Previous Address, if current is less than 12 months.

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Check type of employment desired:

 

Check days available:

 
 
Are you able to lift?
 
Legally Able To Work In The Us
 
Over The Age Of 18
 
A Previous Employee Of Dco
 

If so, please explain below

 
This position may require transporting individuals in a personal vehicle (mileage paid). Do you have a vehicle to use while on shift?
 
 

Education

Name Location No. of Years Attended Did You Graduate Subjects Studied

Additional Certifications or Qualifications

Former Employers

Name of Employer
Address City
State Zipcode
Starting Date --
Leaving Date --
Job Title
Starting Salary Ending Salary
Name of Supervisor Supervisor's Title
Employer's Phone Number May we contact this employer?
Description of work Reason for leaving
 
Name of Employer
Address City
State Zipcode
Starting Date --
Leaving Date --
Job Title
Starting Salary Ending Salary
Name of Supervisor Supervisor's Title
Employer's Phone Number May we contact this employer?
Description of work Reason for leaving
 
Name of Employer
Address City
State Zipcode
Starting Date --
Leaving Date --
Job Title
Starting Salary Ending Salary
Name of Supervisor Supervisor's Title
Employer's Phone Number May we contact this employer?
Description of work Reason for leaving
 
Name of Employer
Address City
State Zipcode
Starting Date --
Leaving Date --
Job Title
Starting Salary Ending Salary
Name of Supervisor Supervisor's Title
Employer's Phone Number May we contact this employer?
Description of work Reason for leaving
 

References

Name Address Business Years Known Phone
Have you had any moving violations in the past 3 years?
 
Other than traffic violations, have you ever been convicted of a crime?
 
Have you been convicted of a felony within the last 5 years?
 
Has child/elder abuse/neglect been investigated and/or substantiated?
 

If you have answered Yes to any of the previous questions, please explain the circumstances. (This will not necessarily exclude you from consideration for a position.)

AUTHORIZATION

As an applicant for employment or volunteer at the Developmental Center of the Ozarks, I hereby certify that the foregoing statements are true and correct to the best of my knowledge and belief. I grant the Agency permission to verify answers. I understand that any false statement in the application may be considered sufficient cause for rejection of the application, or for dismissal if such false statement is discovered subsequent to my employment. I hereby authorize the Developmental Center of the Ozarks to conduct an investigative consumer report on me, as defined in PL 91.508, and I understand that if any inquiry is made, more information as to its nature and scope will be supplied upon written request. If this application is considered favorably, I agree to abide by and comply with all of the Policies, Procedures, and Guidelines of the Developmental Center of the Ozarks and the Program for which I am hired. I also understand that the offer of employment is not final until it is in writing and signed by an authorized DCO representative.