Careers

Employment Application

Pages 1 and 2 of the JFCS employment application. Some forms are signed in person; see Forms completed in person at the office. Want to refer someone instead? Make a referral.

To apply today, please call (336) 285-7238 or email jfcs0525@gmail.com.

Position

Position applied for

Date

Applicant Information

Full legal name

Address

City

State

ZIP

Phone

Authorized to work in the United States?

Preferred employment Full-time Part-time As needed

Earliest start date

Desired schedule

Availability

Mark days available Mon Tue Wed Thu Fri Sat Sun

Hours / restrictions

Position Requirements and Experience

Valid driver license (if position requires driving)

Reliable transportation for assigned shifts

Relevant experience supporting people with disabilities

Current certifications (CPR, First Aid, medication training, etc.)

Education

Highest level completed / school

Employment History

List your two most recent employers.

Employer 1

Employer / organization

Phone

Job title

Dates worked

Supervisor

Main duties

Employer 2

Employer / organization

Phone

Job title

Dates worked

Supervisor

Main duties

Professional References

Please list two people who can speak to your work. Do not list family members.

Reference 1

Name

Phone / email

Relationship / organization

Reference 2

Name

Phone / email

Relationship / organization

Forms completed in person at the office

These are signed on paper, in person, at our office. They are not collected online:

Applicant certification and signature
Criminal History Disclosure (page 3 of the application)
Background Report Disclosure and Authorization
Hepatitis B vaccination form

Paper employment application (PDF)

Background report disclosure and authorization (PDF)