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Daily Living Skills Training
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Ascend Plant 1

2818 Meadow Lane
Manitowoc, WI 54220

920-682-4663

Monday - Friday
8:00am to 4:00pm

Ascend Plant 2

822 S. 13th Street
Manitowoc, WI
54220

920-682-4663

Monday - Friday
8:00am to 4:00pm

Community Center

2802 Meadow Lane
Manitowoc, WI 54220

920-682-4663

Monday - Friday
8:00am to 4:00pm

Apply Now!

Name *

First

Middle

Last

Maiden Name and/or previous name(s):

First

Middle

Last

Address *

Address Line 1

City

State

Zip Code

Phone *

Email *

What position are you applying for:

How did you hear about the position?

Day Availability (Mark all that apply)

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Time of Day Available (Mark all that apply)

Morning
Afternoon
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I am seeking a: *

Full-time Job
Part-time Job
Seasonal / Temporary

How many hours can you work weekly?

Desired Wage: *

Date available to begin:

Have you ever been employed by this company in the past? *

Yes
No

I certify that I am a U.S. citizen, permanent resident, or a foreign national with authorization to work n the United State? *

Yes
No

Have you ever been convicted of, or entered a plea of guilty, no contest, or had a withheld judgement to a felony? *

Yes
No

If Yes, please explain

Do you have a valid driver's license? *

Yes
No

Driver's license number *

Issued in what state? *

Have you had any accidents during the past three years? *

Yes
No

If yes how many?

Have you had any moving violations during the past three years? *

Yes
No

If yes how many?

Education & Training

High School / GED *

Course of Study *

# of Years Completed *

Did you Graduate? *

Yes
No

Vocational Technical

Course of Study

# of Years Completed

Did you Graduate?

Yes
No

Degree Received

College and / or Graduate

Course of Study

# of Years Completed

Did you Graduate?

Yes
No

Degree Received

Skills & Qualifications

Describe and other Education, Training or Skills. *

Military

Have you ever been in the Armed Forces?

Yes
No

Date entered:

Discharge date:

Are you now a member of the National Guard?

Yes
No

Specialty:

Work Experience

Employer 1

Address

Phone

Employment Start Date

Employment End Date

Starting Wage

End Wage

Name of last supervisor:

Hours worked per week:

Your last job title:

Reason for Leaving

List the jobs you held, duties performed, skills used or learned, etc.:

Employer 2

Address

Phone

Employment Start Date

Employment End Date

Starting Wage

End Wage

Name of last supervisor:

Hours worked per week:

Your last job title:

Reason for Leaving

List the jobs you held, duties performed, skills used or learned, etc.:

Employer 3

Address

Phone

Employment Start Date

Employment End Date

Starting Wage

End Wage

Name of last supervisor:

Hours worked per week:

Your last job title:

Reason for Leaving

List the jobs you held, duties performed, skills used or learned, etc.:

References

Name *

First

Last

Phone *

Email *

Relationship *

Name *

First

Last

Phone *

Email *

Relationship *

Name *

First

Last

Phone *

Email *

Relationship *

May we contact your present employer?

Yes
No

Authorization and Certification

PLEASE READ CAREFULLY BEFORE SIGNING:

I authorize investigation of all statements contained in this application and understand that misrepresentation or omission of facts called for is cause for rejection of this application or dismissal at a later date. Further, I understand and agree that my employment is for no definite period of time and may, regardless of the date of payment of my wages and salary, be terminated at any time without any previous notice.

Applicant Signature *

Today's Date *//

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Ascend Services, Inc. is an equal opportunity employer.