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Wraparound Services of the Hudson Valley

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(845) 336-7235

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Home
About
- Mission
- History
- Board
- Leadership
- Compliance
- Contact
Services
Careers
Accessibility Awareness Day
- About
- Register
- Sponsors
- History
- Gallery
Accreditation
- CQL
- PBIS

APPLY NOW

Name(Required)

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email(Required)

If under 18 years of age, do you have a work permit?

Yes

No

Are you either a US citizen or an alien who has the legal right to remain and work in the USA? (You will be required to furnish proof of lawful work status if you are extended a job offer.)*

Yes

No

Postion(s) applied for(Required)

Were you previously employed by us?(Required)

Yes

No

If yes, when?

List any friends or relatives employed by us(Required)

Have you ever been bonded?(Required)

Yes

No

Have you ever been convicted of a crime?(Required)

Yes

No

If your application is considered favorably, on what date will you be available for work?(Required)

Are there any other experiences, skills, or qualifications which will be of special benefit in the job for which you are applying? (Applicant should not list any information that Federal and/or State law precludes obtaining in the pre-employment state.)

Highest Grade Completed - Grade School

1

2

3

4

5

6

7

8

9

10

11

12

Highest Grade Completed - College

1

2

3

4

If you attended College, please indicate the college degree you have received

Associate's Degree

Bachelor's Degree

Master's Degree

PhD

Name of the last school attended

License(s), vocational or trade training

Any additional education and where

May we contact your current employer?

Yes

No

Name of Current Employer

Name of Immediate Supervisor

Address of Current Employer

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number of Current Employer

Job title and brief description of job duties/experience

Number of hours worked per week

Reason for Leaving

Name of Previous Employer - 1

Name of Immediate Supervisor

Address of Previous Employer

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone number of Previous Employer

Job title and brief description of job duties/experience

Number of hours worked per week

Reason for Leaving

Name of Previous Employer - 3

Start Date

End Date

Name of Immediate Supervisor

Address of Previous Employer

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number of Previous Employer

Job title and brief description of job duties/experience

Number of hours worked per week

Reason for Leaving

Do you hold a current/valid NYS Driver's License?(Required)

Yes

No

Have you had any motor vehicle violations in the past six (6) years?(Required)

Yes

No

Have you had any convictions related to moving violations in the last three (3) years?*(Required)

Yes

No

Have you had any suspension, revocation, DWI, convictions or any occurence involving harm to anyone or property while driving?*(Required)

Yes

No

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PO Box 1488 Kingston, NY 12402
250 Tuytenbridge Road, Lake Katrine, NY 12449

Phone: (845) 336-7235
Fax: (845) 336-7248
TTY Number: (845) 336-4055

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