Fiend 2 Clean LLC

PO Box 875032, Wasilla, Alaska 99687

(907) 982-4673

 

 JOB APPLICATION

Fiend 2 Clean LLC is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative.

Please fill out all of the sections below:

 

Applicant Information

Applicant Name:

 

Address:

 

City, State and Zip Code:

 

Telephone Number:

 

Email Address:

 

 

Date of Application:

 

 

 

Employment Position

Position(s) applying for:

 

How did you hear about this position?

 

What days are you available for work?

 

What hours or shift are you available for work?

 

If needed, are you available to work overtime?

 

On what date, can you start working if you are hired?

 

Do you have reliable transportation to and from work?

 

Salary desired:

 

 

Personal Information

Are you 18 years of age or older?

Yes

No

Are you a U.S. citizen or approved to work in the United States?

Yes

No

 

 

 

 

 

 

 

 

 

Will you consent to Random controlled substance testing?

Yes

No

Do you have any condition which would require job accommodations?

Yes

No

If yes, please describe accommodations required below.

 

 

 

 

 

 

 

Have you ever been convicted of a criminal offense (felony or misdemeanor)?

Yes

No

If yes, please state the nature of the crime(s), when and where convicted and disposition of the case:

 

 

 

 

 

 

 

 

 

 

 

 

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)

 

 

Job Skills/Qualifications

Please list below the skills and qualifications you possess for the position for which you are applying:

 

 

 

 

 

 

(Note: Fiend 2 Clean LLC complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. )

 

 

Education and Training

 

High School

Name

Location (City, State)

Year Graduated

Degree Earned

 

 

 

 

 

College/University

Name

Location (City, State)

Year Graduated

Degree Earned

 

 

 

 

 

Vocational School/Specialized Training

Name

Location (City, State)

Year Graduated

Degree Earned

 

 

 

 

 

Military:

Are you a member or veteran of the Armed Services?

 

 

 

Previous Employment

Employer Name:

 

Job Title:

 

Supervisor Name:

 

Employer Address:

 

Salary:

 

Employer Telephone:

 

Dates Employed:

 

Reason for leaving:

 

 

Employer Name:

 

Job Title:

 

Supervisor Name:

 

Employer Address:

 

Salary:

 

Employer Telephone:

 

Dates Employed:

 

Reason for leaving:

 

 

Employer Name:

 

Job Title:

 

Supervisor Name:

 

Employer Address:

 

Salary:

 

Employer Telephone:

 

Dates Employed:

 

Reason for leaving:

 

 

                                                May we contact your previous/current Employer’s?   __________________

References

Please provide 3 personal and 2 professional reference(s) below:

 

Reference

Time Known

Company/personal

Contact Information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional Information:

Please Describe why you are interested in working as a Peer Support Specialist.

 

 

 

Please describe your relative experience working with individuals with a substance use disorder, both professionally and/or personally.

 

 

 

Peer support specialist's offer mentorship and guidance, please describe why you believe you a good candidate to provide mentorship.

 

 

 

Please describe your Views on Medicated Assisted Treatment such as Vivitrol, Suboxone, and/or Methadone.

 

 

 

Fiend 2 Clean LLC has a zero-tolerance policy on substance Use to include alcohol. Do you have at least one year of complete and continuous abstinence?

 

 

 

 

AT-WILL EMPLOYMENT

The relationship between you and the Fiend 2 Clean LLC is referred to as "employment at will."  This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Fiend 2 Clean LLC.  No representative of Fiend 2 Clean LLC has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status.

 

 

Applicant Signature:

 

Dated:

 

  

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