Application for Employment


Vision Loss Resources Employment Application

  • Employment Application

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Education

    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.
  • If current employed leave blank
  • References

    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.
  • This field is for validation purposes and should be left unchanged.