Employee Application:

Personal Info:

Full Name:

Your Pronouns

Do you have a preferred name?:

Phone Number

Email

Address

SSN#:

Desired Start Date:

Desired employment type:

Desired Pay $ (USD-Hourly)

Employment Eligibility

Are you eligible to work in the U.S.?

Have you ever been CONVICTED of a felony? If yes, please explain:

Do you have a valid driver's license?

Do you have a mode of transportation?

CM, CBRS, & CPSS are required to have reasonable transportation that can accommodate clients, and insurance on said vehicle.

Are you willing to or can you reasonably commute to Boise, ID?

Yes

No

Voluntary Self Identification

"Our company is an Equal Opportunity/Affirmative Action employer. We are required by law to provide equal employment opportunity to qualified individuals and to collect information about our applicants' and employees' disability, veteran, and race/ethnicity status. Completing this form is entirely voluntary. Whether or not you choose to provide this information will have no impact on your employment or opportunities for promotion. Your response will be kept confidential and used only for government reporting and analysis as required by law."

Voluntary Self-Identification of Disability: Please check one of the boxes below:

YES, I HAVE A DISABILITY (or have had one in the past)

NO, I DON'T HAVE A DISABILITY

I DON'T WISH TO ANSWER

The OFCCP defines a disability as a physical or mental impairment or medical condition that substantially limits a major life activity, or a history or record of such an impairment or medical condition.

Voluntary Self-Identification of Veteran Status: Please indicate your veteran status by checking the appropriate box(es) below. You may select more than one.

Voluntary Self-Identification of Race/Ethnicity: This follows the EEOC's standard classifications.

Education

What is your education level and degree type, if any?:

CM & CBRS are required to have a BS or BA in Human Resources.

Graduation (start to end) date:

Example. 09/2010 - 07/2014

State:

Certifications:

Upload Resume

Please include any related previous employment & reference contact

Upload Related certifications

Background Check Consent

If asked, Are you willing to consent to our background check process?

Yes

No

Our process includes a background check conducted by the Department of Health and Welfare, as well as a separate background check conducted by a third-party agency.

Disclaimer

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any misrepresentation or omission of facts may be grounds for disqualification from consideration or, if hired, immediate termination of employment.

I acknowledge that T.O.T.E.M.H. LLC is an Equal Opportunity Employer and values a diverse workforce. To ensure my application is considered, I have completed all sections of this form in their entirety, even though I have attached a resume.

Signature

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