Name*

Street Address*

City*

State*

Zip Code*

Telephone Number*

Cell Phone Number

E-Mail Address

Do you Have a High School Diploma/GED?*

Do You have a Bachelor's Degree?

List All Post-High School Education Completed. Include Dates Attended, Degree and Major.

Direct Service positions at WorkAbilities, Inc. involve rigorous physical activities which may include the physical ability to 1) stand and walk for up to seven hours a day 2) perform two-person lifts of adult clients throughout the day, including squatting, pivoting, flexing and kneeling; 3) independently roll, position or complete ROM/Stretching exercises with clients 4) push clients in wheelchairs on both level and incline surfaces 5) engage in repetitive lifting or other physical movements in care of clients or in fulfilling production demands. Are you able with or without reasonable accommodation, able to perform all of these job functions?*

Employment Offer is contingent on the employee demonstrating the safe ability to perform essential tasks on a Physical Abilities Test.

Do you understand and agree that you will be required to take the Physical Abilities Test and that employment is contingent on demonstrating the safe ability to perform essential tasks? *

Current or Most Recent Employer

Address

Telephone Number*

Job Title

Job Responsibilities

Reason for Leaving

Employer

Address

Telephone

Job Title

Job Responsibilities

Reason for Leaving

Do you have a valid Minnesota Driver's License*

Driver License Number

Are you Legally Eligible for Employment in the U.S.? *Proof of U.S. Citizenship immigration status will be required upon employment.*

Please Read: WorkAbilities, Inc. does not discriminate in employment, and no question on this application is used for the purpose of limiting or excluding any applicant's consideration for employment on a basis prohibited by local, state, or federal law.
WorkAbilities extends equal employment opportunity to all applicants and employees and to all aspects of the employment relationship, including, but not limited to, recruiting, hiring, promotion, transfer, and compensation. WorkAbilities does not discriminate against applicants for employment, employees, clients, or members of the general public on the basis of an individual's protected class status including race, color, national origin, religion, sex, sexual orientation, pregnancy, age, disability, marital status, veteran status or public assistance status.
Any employee or applicant for employment who believes s/he has been treated in a way that violates this policy should contact the Quality Management Director 7400 Laurel Avenue, Golden Valley, MN 55426, 763.541.1844 or any other management representative. Contact information is available via our website www.WorkAbiliteis.org. The company will take immediate action to investigate and address allegations of discrimination or harassment confidentially and promptly.
WorkAbilities evaluates the performance of its management and supervisory personnel on the basis of their involvement in achieving these Affirmative Action objectives as well as other established criteria. In addition, all employees are expected to perform their job responsibilities in a manner that supports equal employment opportunities.
I give WorkAbilities, Inc. the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability WorkAbilities, Inc. and its representatives for seeking such information and all other persons, corporations, or organizations from furnishing such information. It is understood and agreed that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from WorkAbilities, Inc.'s services if I have been employed. I also understand that employment is contingent on successful completion of a background study and clearance from the Department of Human Services. Furthermore, I understand that just as I am free to resign at any time, WorkAbilities Inc. reserves the right to terminate my employment at any time, with or without cause, and without prior notice. I understand that no representative of WorkAbilities, Inc. has the authority to make any assurances to the contrary. Include your name below to acknowledge that you understand and agree to these terms.

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Referral Source:

Additional Education, Training or Experience you would like to add: