In order to expedite our application process, we ask that you supply us with the following pre-screening information.

A Human Resources Assistant will contact you regarding the rest of the application process.  If you have any questions, feel free to contact our Human Resources Department at 315.788.2730.
 

Full Name (First, Middle Initial, Last)

Street Address

City / State / Zip

Home Phone*

Work Phone (Optional)

Cell Phone (Optional)

Email Address

Education
None
 GED
High School Diploma
Associate's Degree
Bachelor's Degree
Master's Degree
PhD

Field of Study

Certifications/Licenses
(Please list any certifications or licensures you may possess (ie: RN, LPN, SLP, OT, PT, COTA, PTA, Speech Therapist.  PLEASE INDICATE THE STATE IN WHICH YOU ARE LICENSED)

 Special Trade Skills:

 Pallet Jack
 Custodial Machinery
 Fork Lift Operator
 Heavy Equipment Operator
 Maintenance Machinery
Other Trade Skill (Specify)

Department(s) Interested In:

Clinical
Day Programming
Ft. Drum Dining Facility
Ft. Drum C.I.F.
Ft. Drum Custodial
Ft. Drum Recycling
Internship
Maintenance
Preschool/Early Intervention/Day Care
Residential
Service Coordination
Supported Employment Services
Transportation
Vocational Coordination/Services
Wellesley Island Border Station

Preferred Status:

Part Time
Substitute
Temp/Seasonal/School Breaks

Preferred Work Shift:
Afternoon
Evenings
Overnight
Split Shift

Preferred Hours

 Additional Comments

Signature (Please Type Your Name)