Employment Application Step 1 of 3 33% Twin Valley Developmental Services, Inc. 413 Commercial St., Greenleaf, KS 66943Applicant InformationName* First Middle Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email Date Available MM slash DD slash YYYY Referral (List Twin Valley Employee) Are you interested in full-time or part-time work?* Full-time Part-time Either Social Security Number Are you a citizen of the United States?* Yes No Have you ever worked for this company? ** Yes No Have you ever been convicted of a felony? ** Yes No EducationDo you have a High School diploma or GED?* Yes No Did you attend college?* Yes No Other Previous EmploymentCurrent/Last EmployerCompany Phone NumberAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor Job Title Starting Salary Ending Salary ResponsibilitiesFrom Month Day Year To Month Day Year Reason for Leaving Additional InformationDid you serve in the military?* Yes No What are your strengths and weaknesses? Why are you qualified for this position?How did you hear about this opportunity? Disclaimer* I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my termination of employment. I understand that my statements and references can be investigated. Age Disclaimer* I am 18 years of age or older Applicant is 18 years of age or older (With a lot of our vehicles, electric lifts, etc., the applicant has to be at least 18)We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, handicap or national origin.NameThis field is for validation purposes and should be left unchanged.
