Employment Application

Personal Information

Name *

First

Last

Date *

Position Applying For *

Phone *

Email *

LinkedIn or Indeed profile

Address *

Address Line 1

City

State

Zip Code

Are you over 18? *

Education

High School – Name & Location

High School – Date of Graduation

Post Secondary – Name & Location

Post Secondary – Date of Graduation

Major Field of Study *

Professional Reference

Name *

Employed By *

Phone *

Professional Reference

Name

Employed By

Phone

Personal Reference

Name *

Employed By *

Phone *

PLEASE NOTE:

All offers of employment at Fraser, Ltd. are contingent upon clear results of a thorough background check. Background checks will be conducted on all final candidates.

Reference Release Form

By applying for a job a Fraser, Ltd., which provides services to adults with intellectual/developmental disabilities, children, and youth, I realize the agency must be selective of the people it hires. I understand that Fraser, Ltd. and its personnel, in order to make a knowledgeable decision as to my being hired, must check with prior employers and other references.Therefore, I consent to and authorize Fraser, Ltd. personnel to contact any or all the references I have listed regarding information concerning my ability to adequately perform the job requirements, and I know that a complete answer is important to my being hired. Thereby, I release and hold harmless all parties and persons connected with any request for information from all claims, liability, and damages for whatever reason arising out of furnishing the information.

Consent to authorize Fraser, Ltd personnel to contact any or all references listed. *

Yes, I give Fraser, Ltd. consent to contact my references

If I worked for any of my former employers under a different name, my name at that time was:

Background Check *

I authorize Fraser LTD. to conduct a background check as part of the application process.

North Dakota State Century Code requires the completion of a criminal offense conviction reporting form.

This form is required by all individuals listed below. Please select the appropriate category. *

Individual member of the governing Board
Chief Executive Officer
Any employee or agent who receives or disburse funds on behalf of the Board
Any employeed who provides any direct care to clients
All employees

In the event of a conviction for a criminal offense, Fraser, Ltd. is by law, required to report and validate this conviction with the State of North Dakota *

I have not been convicted of a criminal offense
I have been convicted of a criminal offense

Type of Criminal Offense

Date

Employment History

Name and Address of Firm/Agency *

Phone *

Supervisor's Full Name *

Dates of Employment *

Month/Year – Month/Year

Position Held *

Hourly Salary *

Reason for Leaving *

Duties Performed (or attach Resume) *

Past Employment

Name and Address of Firm/Agency *

Phone *

Supervisor's Full Name *

Dates of Employment *

Month/Year – Month/Year

Position Held *

Hourly Salary *

Reason for Leaving *

Duties Performed (or attach Resume)

Upload Your Resume *

Drag & Drop Files, Choose Files to Upload

General

If hired, what is your salary expectation? *

When are you available to begin work? *

Emergency Contact Name & Relationship *

Emergency Contact Phone *

Emergency Contact Address *

Address Line 1

City

State

Zip Code

Other

Driving Information

Do You Have a Valid Driver's License? *

Driver History

List if you have ever been cited for any of the following violations while operating either your own personal automobile or those of others:

Have you ever been cited for any driving violations? *

How many accidents have you been in during the past five years (regardless of fault) while operating an automobile? *

Give dates and explanation of each. *

Have you ever had your Driver's License suspended? *

If yes, enter the DATE and REASON below.

Name of Insurance Company *

EEO-1 Voluntary Self Identification Form

The Equal Employment Opportunity Commission (EEOC) requires all private employers with 100 or more employees as well as federal contractors and first-tier subcontractors with 50 or more employees AND contracts of at least $50,000 complete an EEO-1 report each year. Covered employers must invite employees to self-identify gender and race for this report.Completion of this form is voluntary and will not affect your opportunity for employment, or the terms or conditions of your employment. This form will be used for EEO-1 reporting purposes only and will be kept separate from all other personnel records only accessed by the Human Resources department. Please return completed forms to the HR department.If you choose not to self-identify your race/ethnicity at this time, the federal government requires Fraser, Ltd to determine this information by visual survey and/or other available information.

Name

First

Last

Gender

Male
Female
Other

Race / Ethnicity

Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race
White (Not Hispanic or Latino): A person having origins in any of the original peoples of Europe, the Middle East or North Africa
Black or African American (Not Hispanic or Latino): A person having origins in any of the black racial groups of Africa
Native Hawaiian or Pacific Islander (Not Hispanic or Latino): A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands
Asian (Not Hispanic or Latino): A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam
Native American or Alaska Native (Not Hispanic or Latino): A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment
Two or more races (Not Hispanic or Latino): All persons who identify with more than one of the above five races
I do not wish to disclose

* PLEASE NOTE: If hired, Fraser, Ltd.'s insurance company will verify your driver's record in the state you hold our driver's license.

* PLEASE NOTE: If hired, North Dakota Administrative Code 75-04-01-06 requires that Fraser, Ltd. conduct criminal background checks on all persons employed to work with individual and to disclose that information to the Department of Human Services.
* PLEASE NOTE: If hired, Fraser, Ltd. will require that all new employees consent to submit to urinalysis and/or other tasks as shall be determined by Fraser, Ltd. in the selection process of applicants for employment.

All Information is Correct *

I have read this application and declare that all the information provided on this application is true. Any falsification or misrepresentation will be sufficient grounds for my release from employment.

Date *

Phone

Personal Information

Education

Professional Reference

Professional Reference

Personal Reference

PLEASE NOTE:

Reference Release Form

Employment History

Past Employment

General

Driving Information

Driver History

EEO-1 Voluntary Self Identification Form

Contact us, we would love to hear from you.

About

Community

Services

Support