APPLICATION FOR EMPLOYMENT

(Please Print)

PERSONAL DATA

Name: ____________________________________________                 ____________________________________________ Last             First                              MI                    Social Security Number

________________________________________________________________________________________________

Street Address                          City                  State                 Zip Code                       Telephone Number                                                      

How did you hear about this position? □ Employee Referral: ________________________(provide us with full name of employee)

□ Newspaper   □ State Job Service   □ Internet      □ Job Fair  □ Other: _______________________________ (please specify)

Position Applied For: ______________________________________________________________________________

Hours/Days Desired:    □ Full Time  □ Part Time  □ Summer  □ Internship  □ Work-Study  □ Volunteer (non paid)

                                   □  Mornings  □ Evenings   □ Awake Overnights      □  Weekends

If Hired, Date Available: _________________________________________________

Have you ever worked for or applied to Turning Point before?                                                                  Yes  No

If yes, please give dates of employment or application.______________________________________________________

Do you have any relatives or friends who work here at Turning Point, Inc.?                     Yes  No

If so, please give name and relationship. _________________________________________________________________

Are you at least 18 years of age?                                                                                                           Yes    No

Are you legally authorized to work in the United States?                                                              Yes    No

If you are not a U.S. Citizen, do you have a valid work permit or otherwise authorized to               Yes    No

work in the United States? (If you are offered employment, then appropriate documentation will be required to

verify your legal right to work in the United States).

Please read this carefully before answering the following questions:

Have you ever been convicted of a felony?                                                                                  Yes  No

If yes, explain______________________________________________________________________________________

Have you been convicted of a misdemeanor within the last 5 Years?  (Do not include a first conviction for drunkenness, simple assault, speeding, minor traffic violations, affray or disturbance of the peace.)                    Yes  No

If yes, explain.______________________________________________________________________________________

An applicant for employment with a sealed record on file with the commissioner of probation may answer “no record” with respect to any inquiry herein relative to prior convictions.  In addition, any applicant for employment may answer “no record” with respect to any inquiry relative to prior adjudication’s in all cases of delinquency or as a “child-in-need-of-services”, which did not result in a complaint transferred to the superior court criminal prosecution.

Do you have a valid driver driver’s license? DL # ___________________ Type: _____ State: ________           Yes  No

Do you have reliable transportation for traveling to and from work if hired?  Yes  No

EDUCATION

Dates Attended

From             To                    Name of School                             City & State                            Degree

________     _________      _________________________   ______________________ ____________________

High School                                                                                High School diploma or GED copy must be provided

________     _________      _________________________   _______________________ ____________________

Trade or Technical School

________     _________      _________________________   _______________________ ____________________

College

________     _________      _________________________   _______________________ ____________________

Other courses/schooling,

                                                            (including apprenticeship)                       Other Job-Related Skills/Training:

                                                                                                                                  ________________________________________________

                                                                                                                                  ________________________________________________

Do you have the following trainings and/or certificates? Original certificate cards or copies will be requested to be provided

□ CPR                □ First Aid                    □ MED           □ PAC             □ Fire Safety                □ Sign Language

□ Other: _________________________________________________________________________________________             

EMPLOYMENT HISTORY Please begin with your current or most recent employer.  You may include voluntary work.

Please complete fully even if you have a resume.

_____________________________________________                  _____________________________________________

Employer                                                                                  Dates of Employment

_____________________________________________                  _____________________________________________

Address                                                                                    Telephone Number

_____________________________________________                  _____________________________________________

Title                                                                                          Duties

____________________________________________                    ____________________            ___________________

Reason for Leaving                                                                   Starting Salary                           Ending Salary

____________________________________________                    May we contact this employer?               Yes  No

Supervisor’s Name/Title

_____________________________________________                  _____________________________________________

Employer                                                                                  Dates of Employment

_____________________________________________                  _____________________________________________

Address                                                                                    Telephone Number

_____________________________________________                  _____________________________________________

Title                                                                                          Duties

____________________________________________                    ________________                ___________________

Reason for Leaving                                                                   Starting Salary                          Ending Salary

_____________________________________________                  May we contact this employer?               Yes  No

Supervisor’s Name/Title

_____________________________________________      _____________________________________________

Employer                                                                                  Dates of Employment

_____________________________________________                  _____________________________________________

Address                                                                                    Telephone Number

_____________________________________________                  _____________________________________________

Title                                                                                          Duties

_____________________________________________                  __________________                        ___________________

Reason for Leaving                                                                   Starting Salary                           Ending Salary

_____________________________________________                  May we contact this employer?               Yes  No

Supervisor’s Name/Title

Turning Point is committed to a policy of Equal Employment Opportunity and will not discriminate regarding employment opportunities or practices on the basis of race, color, religion, sex, national origin, age, disability, or any other characteristic protected by law.

PLEASE READ CAREFULLY AND SIGN THE STATEMENT BELOW

I certify that the information given above is true and complete, and I understand that misrepresentation and/or withholding of information will result in the rejection of this application or my discharge if discovered after employment begins. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records.  I authorize all persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information.  I also understand that the use of illegal drugs is prohibited during employment.  If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.

Employment with Turning Point, Inc. is at the mutual consent “at will” of Turning Point, Inc. and its employees, and either party may terminate that relationship at any time, with or without cause, and with or without advance notice.

Applicant’s Signature________________________________________ Date____________________________

By signing above, I verify that I have completed this application on my own and in my own handwriting

While Turning Point, Inc. does not require or request of its employees to take a lie detector test, State law requires the following notice:  “It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.”

REFERENCES FOR: _________________________________________  SS#: ________________________________

Applicant:  Please complete the boxed sections below by furnishing three business references (either your            current and/or past manager, supervisor, clients and/or or customers). DO NOT furnish personal references. Please make sure you sign and date the release at the bottom of each reference page.

PLEASE PRINT

TO: Company Name: _________________________________________________________________

Street Address:    _______________________________________________________________

Town, State, Zip: ________________________________________________________________

Attn:                  _________________________________________________________________

RE: APPLICANT __________________________ SS#: __________________________________

            Position Held: ____________________________Employed   From: _________ To __________

Dear Sir/Madam:

            Your current or former employee has given us permission to contact you for confidential information regarding their work performance while in your employ.  Your cooperation in responding will assist us in making an employment decision.  Please rate the applicant by check mark on the following items:

                                                                          EXCELLENT      SATISFACTORY   UNSATISFACTORY

ATTENDANCE

PUNCTUALITY

QUALITY OF WORK

MOTIVATION/JOB INTEREST

COOPERATION WITH OTHERS

WORK ORGANIZATION

Eligible for rehire?          Yes ____ No ___If not please, comment_______________________________

Signature: __________________________ Title: _________________________ Date: _____________

IMPORTANT APPLICANT PLEASE COMPLETE

Applicant:  Please sign and date below:

I have supplied Turning Point Inc. with the information above regarding my employment with you. You have my permission to reply from your records without being subject to any action or recourse from me.

Date: __________________ Applicant Signature: __________________________________

REFERENCES FOR: _________________________________________  SS#: ________________________________

Applicant:  Please complete the boxed sections below by furnishing three business references (either your            current and/or past manager, supervisor, clients and/or or customers). DO NOT furnish personal references. Please make sure you sign and date the release at the bottom of each reference page.

PLEASE PRINT

TO: Company Name: _________________________________________________________________

Street Address:    _______________________________________________________________

Town, State, Zip: ________________________________________________________________

Attn:                  _________________________________________________________________

RE: APPLICANT __________________________ SS#: __________________________________

            Position Held: ____________________________Employed   From: _________ To __________

Dear Sir/Madam:

            Your current or former employee has given us permission to contact you for confidential information regarding their work performance while in your employ.  Your cooperation in responding will assist us in making an employment decision.  Please rate the applicant by check mark on the following items:

    EXCELLENT      SATISFACTORY   UNSATISFACTORY

ATTENDANCE

PUNCTUALITY

QUALITY OF WORK

MOTIVATION/JOB INTEREST

COOPERATION WITH OTHERS

WORK ORGANIZATION

Eligible for rehire?          Yes ____ No ___If not please, comment_______________________________

Signature: __________________________ Title: _________________________ Date: ______________

IMPORTANT APPLICANT PLEASE COMPLETE

Applicant:  Please sign and date below:

I have supplied Turning Point Inc. with the information above regarding my employment with you. You have my permission to reply from your records without being subject to any action or recourse from me.

Date: __________________ Applicant Signature: __________________________________

REFERENCES FOR: _________________________________________  SS#: ________________________________

Applicant:  Please complete the boxed sections below by furnishing three business references (either your            current and/or past manager, supervisor, clients and/or or customers). DO NOT furnish personal references. Please make sure you sign and date the release at the bottom of each reference page.

PLEASE PRINT

  TO: Company Name: _________________________________________________________________

Street Address:    _______________________________________________________________

Town, State, Zip: ________________________________________________________________

Attn:                  _________________________________________________________________

RE: APPLICANT __________________________ SS#: __________________________________

            Position Held: ____________________________Employed   From: _________ To __________

Dear Sir/Madam:

            Your current or former employee has given us permission to contact you for confidential information regarding their work performance while in your employ.  Your cooperation in responding will assist us in making an employment decision.  Please rate the applicant by check mark on the following items:

   EXCELLENT      SATISFACTORY   UNSATISFACTORY

ATTENDANCE

PUNCTUALITY

QUALITY OF WORK

MOTIVATION/JOB INTEREST

COOPERATION WITH OTHERS

WORK ORGANIZATION

Eligible for rehire?          Yes ____ No ___If not please, comment_______________________________

Signature: __________________________ Title:_________________________ Date: ______________

IMPORTANT APPLICANT PLEASE COMPLETE

Applicant:  Please sign and date below:

I have supplied Turning Point Inc. with the information above regarding my employment with you. You have my permission to reply from your records without being subject to any action or recourse from me.

Date: __________________ Applicant Signature: __________________________________