Application for Employment


Vision Loss Resources Employment Application

Employment Application

MM slash DD slash YYYY
Are you applying for:(Required)
Can you perform the essential functions of the position you are applying for?(Required)
Under federal law, we may hire only persons authorized to work in the U.S. As a condition of employment, I understand that I will be required to furnish proof of my idenity and authorized to work in the U.S. as required by law. Are you legally authorized to work in the United States?(Required)
Will you now or in the future require sponsorship for the employment visa status? (e.g., H-1B visa status)(Required)
Are you employed now?
MM slash DD slash YYYY
Do you have a valid driver's license?(Required)


Please list Education level, name and location of school, years completed and degree awarded.

Employment Record

Please give accurate, complete full-time and part-time employment history starting with your present or most recent employer. If attaching resume, you must still complete all sections.
Date of Hire
Last day of employment
If current employed leave blank


List three professional references was may contact (e.g., current or former managers, peers, customers, etc.).

Please Read and Certify the Following

Vision Loss Resources (VLR), DeafBlind Services Minneapolis (DBSM) and Contract Production Services (CPS) are Equal Opportunity Employers. Prospective employees will receive consideration without discrimination because of race, color, creed, religion, national origin, sex, marital status, status with regard to public assistance, membership or active in local commission, disability, sexual orientation, genetic testing information, age or any other characteristic by state or federal law. - I certify that the statements that I have made in this application are true and complete and that I have read, understand, and agree to all the provision contained in this application or violation of any of the provisions contained herein may be cause for disqualification or immediate dismissal. -In consideration of my employment, I agree to conform to the policies an procedures of VLR, DBSM, and CPS. I understand that in accepting this application, the organization is in no way obligated to provide me with employment and that I am not obligated to accept employment if offered. Furthermore, if employed with VLR, DBSM, and CPS, I understand that I am employed "at-will" and that my employment and compensation can be terminated with or without cause, and with or without notice at any time, at either the opinion or the organization or myself. I further understand that no supervision, manager, or representative of the Company has authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, except in writing when authorized by the CEO of VLR, DBSM, and CPS. -I authorize VLR, DBSM, and CPS to investigate all statements contained herein and to use the information contained in this application form or in my personnel file; (1) to contact my previous employers about my qualification for the job applied for (2) to answer job related inquiries from possible future employers, (3)to contact schools for pertinent information, and (4)to contact the references listed above. I understand that this application form will be considered active for six (6) months from the date it is signed and dated by me. -I understand that if I am offered employment the organization may require and perform a criminal background check and I may be subject to drug testing.
Max. file size: 128 MB.
Max. file size: 128 MB.