Road To Responsibility : About Us : RTR Career Opportunities : Application

We are an equal opportunity employer dedicated to a policy of non-discrimination in employment on any basis including, race, creed, color, age, sexual orientation, gender, religion, or national origin.

Personal Information

First Name

Middle

Last

Street Address

City/State/Zip

Home Telephone Number

Alternate Telephone Number

E-mail Address

What position are you applying for?

Date available to start

Days and hours available to work

Sunday

Days

Overnight

Monday

Days

Overnight

Tuesday

Days

Overnight

Wednesday

Days

Overnight

Thursday

Days

Overnight

Friday

Days

Overnight

Saturday

Days

Overnight

How did you learn about RTR?

Do you have any relatives who are employed at RTR?

Have you ever applied for employment with RTR? Have you ever been employed by RTR If yes, where? When?

Are you legally authorized to work in the United States?

Do you have a current Driver's License? If yes, from what state?

Education

High School

Area of Concentration

Did you graduate?

Diploma, Degree Or Certificate Received

College

Area of Concentration (Major)

Did you graduate?

Diploma, Degree Or Certificate Received

Other Education

Area of Concentration (Major)

Did you graduate?

Diploma, Degree Or Certificate Received

Other Education

Area of Concentration (Major)

Did you graduate?

Diploma, Degree Or Certificate Received

Employment History

Dates Worked

Name of Employer

Address

Telephone

Job Title/Duties

Please explain your reason for leaving

Dates Worked

Name of Employer

Address

Phone

Job Title/Duties

Please explain your reason for leaving

Professional Licenses of Certificates

Do you have any professional Licenses or certificates?

If yes, please describe

Volunteer Experience

Name of organization

Address

Telephone

Dates of volunteer work

Please describe your duties

References - (2) Professional, (1) Personal

Name

Title

Was this person a direct supervisor?

Employer Name

Telephone #

Alternate Telephone #

Name

Title

Was this person a direct supervisor?

Employer Name

Telephone #

Alternate Telephone #

Name

Relationship

Telephone #

Alternate Telephone #

The Massachusetts Executive Office of Health and Human Services and/or the Department of Mental Retardation require the following:

Have you ever been fired from a job? If so, why?

Have you ever quit a job because you knew you were going to be fired? If so, why?

Have you ever worked for a health or human service agency? If so, why did you leave?

Are you willing to sign a CORI (Criminal Offenders Record Information) permission form and furnish a picture ID

Have you resided outside of the Commonwealth of Massachusetts within the last five (5) years?

If yes, please list all states or countries in which you have resided within the last five (5) years

I understand that all the information I have provided is given under the pains and penalties of perjury

I accept

I understand that no verbal promises or guarantees relating to employment are binding upon the company and that, if employed, I will be an employee "at will" and may be terminated at any time. I understand and agree that any employee handbook or statement of policies and procedures which I may receive will not constitute an employment contract, but will be merely a statement of RTR's current policies. I hereby state that the information given by me in the course of applying for a position is true in all respects. I understand that if I am employed and the information is found to be false in any respect, I will be subject to dismissal without notice at any time. I hereby authorize my former employers, schools and persons listed herein to release information pertaining to my education or work record, my work habits and my work performance, and release Road to Responsibility, Inc. from any liability in connection with efforts to verify and/or receive references regarding my employment or educational history

I accept

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