Employment Application

Please give a complete full-time and part-time employment record dating back no more than 10 years, starting with your present or most recent employer. The accuracy of your information will be verified through a background investigation.

Set forth below the name, address and telephone number of three (3) references not related to you, whom we may contact. At least two (2) must be previous supervisors. Specify affiliation or position.

In the space provided below, please provide a sample of your writing. You can choose from one of the following topics:
1. Why I want to work at Transitional Services for New York, Inc.
2. What I have to offer Transitional Services for New York, Inc.
3. A fictitious Progress Note
4. What do I hope to accomplish by my internship/volunteer placement (for interns and volunteers only)

TSINY is an equal opportunity employer that recruits and employs people without regard to race, creed, color, national origin, sex, ancestry, citizenship, religion, age, gender, marital status, sexual orientation, gender identity, disability, status as a Vietnam-era disabled veteran or other covered veteran, and any additional categories protected by applicable federal, state or local law prohibiting discrimination in employment.

Please Read Carefully and Sign Below

I authorize Transitional Services for New York, Inc. (TSINY) to investigate my educational and employment history and background, and all representations I have made in connections with the process of securing employment at TSINY.

I authorize any prior employer, school, personal reference and other entity or person to disclose to TSINY any and all information concerning me that they may have. I further agree to sign whatever consent forms may be necessary to permit TSINY to obtain and verify such information.

I understand that any offer of employment I may receive from TSINY is contingent upon my successful completion of such an investigation into my background.

I understand that any offer of employment I may receive from TSINY is also contingent upon my satisfactory completion of TSINY’s pre-employment procedures. I will be expected to complete the federal government’s Employment Eligibility Verification Form (I-9) and present documents to verify both my identity and employment authorization.

I also understand that the position for which I am applying may require a motor vehicle report and/or fingerprinting analysis because of the sensitive nature of the work. Should those requirements apply, I accept that fingerprinting and obtaining a copy of my motor vehicle record are additional conditions of employment.

I understand and agree that, if I am hired, my employment will be ‘at will’ and I may be terminated at any time, with or without cause and with or without prior notice. I further understand that this application is not an offer of employment and agree that if an employment relationship is established, my employment can be terminated with or without cause or notice at any time at the option of either TSINY or myself.

I also understand and agree that, if I am hired, I will comply with all the policies, rules, regulations and procedures of TSINY. I understand that the policies and procedures of TSINY are not intended to create or be construed as a contract between me and TSINY, and that TSINY has the sole discretion, within the parameters of the law, to interpret, administer, change or modify its rules, policies, procedures or benefits.

I certify that the information provided in this application, my resumé (if supplied) and during my interview is true and complete to the best of my knowledge. Any false or misleading statements or omissions on this application or my resumé or in my interview(s) will justify refusal of employment or, if I am hereinafter employed by TSINY, termination of employment.

I hereby give my consent to TSINY to verify my driver’s license and any other information it deems necessary.