APPLICATION FOR EMPLOYMENT

Chippewa Enterprises Inc. is an equal opportunity employer and selects the best-matched individual for the job based on job-related qualifications, regardless of race, color, creed, sex, national origin, age, handicap, or other protected groups under state, federal, or Equal Opportunity Laws.
We strive to select staff that will best meet the needs of our consumers.

    * denotes a required field

    First Name*

    Middle Name

    Last Name*

    Street Address*

    City*

    State*

    Zip*

    Email*

    Telephone*

    Drivers License #*

    If no Drivers License, Please explain

    Wage Desired*

    Date You Could Start*

    Time of Day Available*

    Do you have a Criminal Record?*

    General Information

    Employment is not contingent on training in the following areas, however is helpful. Training will be offered upon employment.

    Are you medication certified?*

    Are you CPR certified? *

    If yes, when were you certified:

    Have you completed First Aid Training?*

    Do you know Sign language?*

    Are you familiar with functional teaching methods?*

    Are you familiar with positive behavior modification?*

    Are you trained in range of motion techniques?*

    Are you trained in lifting and transferring?*

    Are you familiar with Diabetes?*

    Are you familiar with TBI?*

    Are you familiar with Epilepsy?*

    Have you worked with individuals with developmental disabilities?*

    Are you able to lift up to 50 pounds?*

    Education

    High School

    Name of School*

    City, State*

    Did You Graduate?*
    YesNo

    College

    Name of School

    City, State

    Diploma/Degree

    Did You Graduate?
    YesNo

    Describe any other training or education that would apply to a position with our agency.
    Please provide any certificates/training records you may have.

    Explain how you may be an asset to Chippewa Enterprises, Inc.

    Employment

    Present / Most Recent Employer

    May we contact your present employer about this application?*
    YesNo

    Company*

    Type of Business*

    Phone*

    Street Address*

    City*

    State*

    Zip*

    Name of Last Supervisor:*

    Title*

    Reason for Leaving*:

    When You Started

    Date*

    Salary*

    Job Title*

    Description of the Job*:

    Currently or When You Left

    Date*

    Salary*

    Job Title*

    Description of the Job*:

    Previous Employer

    Company

    Type of Business

    Phone

    Street Address

    City

    State

    Zip

    Name of Last Supervisor:

    Title

    Reason for Leaving:

    When You Started

    Date

    Salary

    Job Title

    Description of the Job:

    Currently or When You Left

    Date

    Salary

    Job Title

    Description of the Job:

    Previous Previous Employer

    Company

    Type of Business

    Phone

    Street Address

    City

    State

    Zip

    Name of Last Supervisor:

    Title

    Reason for Leaving:

    When You Started

    Date

    Salary

    Job Title

    Description of the Job:

    Currently or When You Left

    Date

    Salary

    Job Title

    Description of the Job:

    References

    Please provide with this application three personal references (not former employees or relatives). Including name, occupation, address, and phone number. Please ask these individuals to mail, email or supply you with reference memos.

    Name*

    Occupation*

    Phone*

    Street Address*

    City*

    State*

    Zip*

    Name*

    Occupation*

    Phone*

    Street Address*

    City*

    State*

    Zip*

    Name*

    Occupation*

    Phone*

    Street Address*

    City*

    State*

    Zip*