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Step 2 of 3

United Cerebral Palsy
9720 N. Rodney Parham Road
Little Rock, AR 72227
Phone: 501-224-6067
Email: hr@ucpcark.org
SECURE APPLICATION FOR EMPLOYMENT
General Information
(Last Name, First Name, Middle Name)

(Social Security Number)

(Street Address)
(City)
(Select State)

(Zip Code)

(Phone Number)

(Cell Number)

(Email Address)
.
Are You At Least 18 Years Old? Have you ever been convicted of a crime or felony?
.
Do you have experience working with individuals with disabilities or care giver?
.
Have you ever worked in this or any other UCP facility?
If yes, which facility?
Are you related to another UCP employee?
.
Current Position(s) for which you are Applying For:
Select CURRENT Positions Applying:Type of Position Preferred:Shift Preferred:





Salary Requirement:Date Available to Start Work {Must be a Date mm/dd/yy}:
Educational History
Type of SchoolSchool(s) InformationSelect Last Year Attended SchoolDegree or Certificate
High School:

Attend Years:
School:
City:
State:

Graduated/GED?
College:

Attend Years:
School:
City:
State:

Graduated?
Degree:
College:

Attend Years:
School:
City:
State:

Graduated?
Degree:
Graduate School:

Attend Years:
School:
City:
State:

Graduated/GED?
Degree:
Employment History (For the Last 10 Years)
Company(s) InformationAbout your Employment
Employment #1

Dates of Employment:


Your Name while Employed:
Company:
City:
State:
Phone:
Reason for Leaving:
Name of Supervisor:
Job Title:
Duties & Responsibilties:
Beginning Salary:
Ending Salary:
Have you ever worked with individuals with disabilities thru another Agency ?
If so, what year(s) were your employed at the Agency?
If currently working for another Agency, what are your hours?
Employment #2

Dates of Employment:


Your Name while Employed:
Company:
City:
State:
Phone:
Reason for Leaving:
Name of Supervisor:
Job Title:
Duties & Responsibilties:
Beginning Salary:
Ending Salary:
Employment #3

Dates of Employment:


Your Name while Employed:
Company:
City:
State:
Phone:
Reason for Leaving:
Name of Supervisor:
Job Title:
Duties & Responsibilties:
Beginning Salary:
Ending Salary:
Employment #4

Dates of Employment:


Your Name while Employed:
Company:
City:
State:
Phone:
Reason for Leaving:
Name of Supervisor:
Job Title:
Duties & Responsibilties:
Beginning Salary:
Ending Salary:
Special Skills & Qualifications (If required for this position.)
(WPM)

Other Noteable skills (50 characters):
Other Noteable skills (Continued) (50 characters):
To continue with this application, please click the "Continue with the Application" button at top of this page.
IMPORTANT: Step 3 of 3 must be completed and "Submit the Application" at top must be clicked.