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* 1. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, genetic information, marital or veteran status, or the presence of a non job related disability.

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* 2. How did you find out about the open positions here at Ark Regional Services?

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* 3. Relatives currently working for Ark Regional Services (Name, relation, and position in which they work).

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* 4. Have you ever been employed by Ark Regional Services?

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* 5. If yes, please answer the following:

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* 6. Are you available full time and/or part time?

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* 7. Days and times you are available to work.

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* 8. Most of our jobs require driving a company car.  

Are you at least twenty years of age?

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* 9. Have you had more than 2 minor traffic violations such as speeding within the last 3 years?

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* 10. Have you had a major violation such as DUI, reckless driving, leaving the scene, or suspended license within the last 5 years?

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* 11. ALL EMPLOYEES AT ARK REGIONAL SERVICES HAVE CONTACT WITH PEOPLE WITH DEVELOPMENTAL DISABILITIES: THEREFORE ALL APPLICANTS MUST COMPLETE THIS SECTION.
Wyoming law requires Ark to screen employees based on criminal convictions, and Ark may choose not to hire an applicant based on criminal convictions other than those excluded by Wyoming law, based on consideration of the circumstances of the conviction. A criminal conviction will not necessarily disqualify you from employment, but failure to include any criminal convictions in the space below will result in the immediate disqualification of you as a candidate or termination of your employment when a conviction is discovered.  The existence of a record of convictions for criminal offenses is not considered an automatic bar to employment.

Have you been convicted of any felony or misdemeanor (including through a jury verdict, a guilty plea, or a “nolo contendere” or no-contest plea)?

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* 12. If yes:

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* 13. Do you have a High School Diploma or GED Certificate?

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* 14. Last high school attended

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* 15. Higher Education

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* 16. List other job-related special qualifications and skills. Include special training, skills with machines including computers, typing or shorthand speed, language skills, memberships in professional associations, honors, awards, publications, licenses or registrations. For licenses and registrations please note expirations dates and license/registration number.

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* 17. Work history: List jobs in reverse order starting with your present or last job. List your entire work history including volunteer, part-time, temporary, self-employment and military jobs. List each promotion as a separate job. This section must be accurate and complete. If more space is needed, attach additional sheets in the same format including your name, social security number and job title. Ark Regional Services will do a complete background verification of your work and Personal history including police records.

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* 18. Personal References
List name, address including street, city, state and zip code and telephone number of three references who are not related and are not previous employers. Providing this information means that you give this organization permission to contact the references listed.

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* 19. APPLICANT’S ACKNOWLEDGEMENTS
(This application shall be considered active for the job vacancy listed and for no more than 60 days. After that time, the applicant will be required to resubmit a completed application. THE APPLICANT UNDERSTANDS THAT NEITHER THIS DOCUMENT NOR ANY OFFER OF EMPLOYMENT FROM THIS EMPLOYER CONSTITUTES AN EMPLOYMENT CONTRACT.)
I certify that all information contained on this application is true and that I have provided complete responses to all requests for information on the application. I give Ark Regional Services and its authorized agents permission to verify and investigate any employment, license, criminal background, and personal reference information given in connection with this application. In the event that I am employed, I understand that any false or misleading information I knowingly provided on my application, during my interview or hiring process may result in discharge and/or legal action.
ACKNOWLEDGEMENT OF AT-WILL EMPLOYMENT I UNDERSTAND THAT IF I AM HIRED BY ARK REGIONAL SERVICES, MY EMPLOYMENT, COMPENSATION AND/OR BENEFITS CAN BE TERMINATED WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT THE OPTION OF EITHER THE ARK OR MYSELF. I ALSO UNDERSTAND THAT NO EMPLOYEE, MANAGER OR SUPERVISOR OF THE ARK HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT OR MAKE ANY PROMISES FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OR TIME OR MAKE ANY STATEMENTS OR PROMISES CONTRARY TO THIS DISCLAIMER, UNLESS SUCH AGREEMENT IS IN WRITING AND SIGNED BY THE CHIEF EXECUTIVE OFFICER. I UNDERSTAND THAT, IF I AM HIRED, NO CONDUCT OR STATEMENT, VERBAL OR WRITTEN WHICH CONTRADICTS THIS DISCLAIMER CAN CONSTITUTE AN EXPRESS OR IMPLIED CONTRACT REGARDING MY EMPLOYMENT, AND I SHOULD NOT RELY ON ANY SUCH CONDUCT OR STATEMENTS.

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