You are applying for: Director of Finance, Community Services for the Developmentally Disabled
(Start with your present or most recent position. Include experience in the armed forces of the U.S. Account for all periods of time. Please fill out all information, even if attaching resume.)
Please list all human services agencies or OPWDD providers that you have worked for in the employment history - attach additional pages if necessary.
Personal: (Please do not include relatives.)
Professional: (Please provide information for present or former supervisors.)
I hereby represent that each answer to a question herein and on any attachments to the application, and all other information otherwise furnished is true and correct. I further represent that such answers and information constitute a full and complete disclosure of my knowledge with respect to the question or subject to which the answer or information relates. I understand that any incorrect, incomplete or false statements or information furnished by me during the selection process will subject me to disqualification from consideration or discharge at any time. I hereby authorize my former employers to give any information regarding my employment with them; and in addition, to furnish any other information they may have concerning me.
I understand this Application for Employment does not constitute an expressed or implied contract of employment and, if hired, I have the right to terminate my employment for any reason at any time. I also understand Community Services reserves the same rights. I understand I may be subject to and I authorize Child Abuse, Criminal Background and Driving Abstract checks by Community Services. I understand this may include the use of fingerprinting. I understand Community Services reserves the right to unilaterally change or modify "wage" and "conditions of employment" at any time without previous notice.
I further understand that in the event I receive an offer of employment, I will be required to submit to a post-offer drug test. The offer of employment will be revoked, or employment will be terminated, in the event of a positive test result. Any offer of employment will be revoked, or employment will be terminated based on adverse information obtained by Community Services, OPWDD, or OMH during the background investigation process.
Note: Employment applications are only considered active for sixty (60) days from receipt. Applications containing stray remarks and/or attachment, and/or information not specifically requested on the application, other than resumes, will be disqualified from further consideration. Incomplete applications may be disqualified from further consideration.
Community Services for the Developmentally Disabled is a drug- free and smoke-free work place.
In compliance with the Fair Credit Reporting Act (Public Law 91-508), you are notified that in connection with and in order to better evaluate this application for employment, a report may be obtained which will provide applicable information concerning character, general reputation and personal characteristics including, but not limited to, verification of prior employment, verification with the Department of Motor Vehicles, and a character check, including verification and review of any criminal convictions. You have the right to make a written request within a reasonable period of time for a complete and accurate disclosure of the nature and scope of the report requested.
I hereby authorize Community Services for the Developmentally Disabled to procure a consumer report as set forth above.
Driver License Information (Must be completed by all applicants for positions that include driving as an essential function of the job. All persons who drive Community Services vehicles must have a valid New York State Driver License. Please see the list provided with this application to see if the position you are applying for requires you to complete this section of the application. If you did not receive a list with this application, please ask our Receptionist for a copy.)
List alcohol or drug related offenses during the past 5 years.
List all other traffic convictions (moving and non-moving violations) during the past 2 years. Do not list parking violations.
during the past 3 years involving persons and/or property.
Access to private transportation is an essential function of many Program positions. Please see the list provided with this application to see if the position you are applying for requires you to complete the question below. If you did not receive a list with this application, please ask our Receptionist for a copy. Any individual accepting one of these positions will be required to use their private transportation throughout the day. If you are applying for one of these positions, please answer the question below.
I understand that this Driver Supplement is an attachment to the Application for Employment and I hereby represent that each answer is true and correct. The Applicant's Agreement on the Application for Employment also applies to my answers on this supplement.
I do hereby authorize a review of and full disclosure of all records concerning myself to Community Services for the Developmentally Disabled, its agents and representatives, whether the said records are of public, private or confidential nature.
The intent of this authorization is to give my consent for full and complete disclosure. I understand that any information obtained by a personal history background investigation, which is developed directly or indirectly, in whole or part, upon this release authorization will be considered in determining my suitability for employment. I also certify that any person(s) who may furnish such information concerning me shall not be held accountable for giving this information, and I do hereby release said person(s) from any and all liability which may be incurred as a result of furnishing such information. I further release Community Services for the Developmentally Disabled, its agents and representatives, from any and all liability, which may be incurred as a result of collecting such information.
Community Services for the Developmentally Disabled is an equal opportunity employer and prohibits discrimination because of race, creed, color, national origin, sex, sexual orientation, age, disability, arrest record, domestic violence victim status or genetic predisposition.
Your criminal background is only one of the factors considered in the employment decision and is evaluated in terms of the nature, severity and date of the offense. No applicant will be excluded from consideration due to prior arrests.
A photocopy of this release will be valid as an original, even though the said photocopy does not contain an original writing of my signature.
I have read and fully understand the contents of this "Authorization for Release of Personal Information."
Identify the state, county or counties in which you have lived over the past seven (7) years.
Corporate Compliance Plan
Annual Report Notice of Privacy Practices
Phone: (716) 883-8888
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180 Oak Street, Buffalo, NY 14203
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