Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Which PACTT program(s) are you applying for? *

School / Transition - Rogers Park (Chicago)

Residential (Children's) - Oak Park, Elmwood Park

Residential (Adult) - Chicago, Oak Park

Adult Vocational Program - Oak Park, Rogers Park

Other

Seeking Full-Time *

Yes

No

Seeking Part-Time *

Yes

No

Have you been previously employed with PACTT? *

Yes

No

May we contact your current employer? *

YES

No

Have you ever been terminated or asked to resign? *

Yes

No

Days Available *

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Hours Available *

Daytime

Evenings

Overnights

Weekends

Do you have a valid state drivers license? *

Yes

No

Have you had more than 2 moving violations in the last 5 years? *

Yes

No

Applicant acknowledgement: *

In consideration of the acceptance and processing of m application for employment, and of my employment with PACTT Learning Center, if I am employed, I hereby warrant and represent as follows: Certification. I certify that I have not knowingly withheld any information that might adversely affect my chances for employment with PACTT and that the information given by me is true and correct without any mental reservation whatsoever. I understand that any omission or misstatement of material fact on my employment application, resume, or any other document used to secure employment with PACTT, or during any pre-employment interview, shall be grounds for rejection of my application or for immediate discharge if I am hired, regardless of the time elapsed before discovery. Reference and Background Check. I authorize PACTT to thoroughly investigate my references, work record, education, and any other matters related to my suitability for employment. I also authorize my former employers to disclose to PACTT any and all of my employment records, including disciplinary reports and letters of reprimand, without giving me notice of such disclosure. I hereby fully release and discharge PACTT, my former employers, their respective officers, employees and agents, and all other persons and entities, from any and all claims, demands, and liabilities arising out of or in any way related to such investigation or disclosure. At-Will Employment. I understand and agree that if I am hired; my employment and compensation are for no definite or determinable period and may be terminated at any time, with or without cause, warning or notice, at the option of either myself or PACTT. I further understand and agree that no representative of PACTT is authorized to make any binding representations or agreements, whether oral or written, contrary to the foregoing or purported to guarantee any particular benefits, terms, or conditions of employment.

I Agree to the terms listed above.

I Disagree with the terms listed above.