Application for Employment

Please read all instructions carefully. You need to answer all questions.

Position(s) for which you are applying: Assistant Cook Support Staff Teacher Therapist
How did you hear about us? (Please mark one): Newspaper Indeed Facebook Job Service
Other Have you applied with us before? Yes No
If yes, when? Is anyone in your family currently employed at White River Academy? Yes No

If yes, who?

To protect your identity we do not require your SSN at the time of application, however, if you are hired you will be required to provide appropriate verification for Federal 1-9 and W-4 documents. If hired, can you provide us with this required verification? Yes No
Utah State Law requires that all WRA staff be at least 19 years of age and pass a Federal BCI (Background Check). If hired can you furnish proof of age? Yes No

Do you have a current driver's license? Yes No
If so, License#: State:

A current BCI IS REQUIRED at all times. Would you be able to pass a Federal Background Check? Yes No

Have you ever been convicted of (or plead guilty to, including pleas in abeyance) any criminal charge (including DUI)? Yes No
If yes, please explain:

Have you lived outside of the State of Utah in the last 5 years? Yes No
If so, where?

Residence: Beginning with the most recent, please list all residences for the past 5 years including college or service-related residences.

Please list all employment related skills, abilities, trainings, or experience that you feel may apply to your desired position at White River Academy

Employment History: Please list all your employers for the past 5 years or the three most recent employers if it is longer than 5 years.

If there are any gaps in your employment history, please explain:

Education: (Start with the most recent and move backward in order of attendance)

References: (Please list 3 past supervisors or other professional references.)

Are you currently CPR & First Aid Certified? Yes No (Required to have at all times)
Do you have a current Food Handlers Permit? Yes No (Only applicable to Kitchen jobs)

Applicant's Authorization to Release Information: By signing your name on the lines provided below, you consent to White River Academy contacting the indicated individual(s) or business(s) and obtaining the information indicated in each subsection. You have the right to decline consent to any or all these subsections by not signing the subsection(s). Know that declining consent might inhibit White River Academy's ability to process and determine your employment eligibility.
In addition to authorizing the release of the information below, I hereby fully waive any rights and/or claims I have or may have against White River Academy, all past employers, educational institutions, and their employees, representatives, and agents from any liability, claims, or damages that may directly or indirectly result from the use, disclosure, or release of any information by any person or party, whether such information is favorable or unfavorable to me.

I, (Applicants Name}, hereby authorize White River Academy to contact my current employer about my job performance.

I, (Applicants Name}, hereby authorize White River Academy to contact my previous employers for references about my job performance.

I, (Name), hereby authorize White River Academy to contact my references for references about my job performance.

I, (Name), hereby authorize all past employers and educational institutions to release the information listed below to White River Academy, its employees, representatives, and agents for use in determining my qualifications for employment.

• Please release and verify the following information: Past employers, dates of employment, positions held, responsibilities and duties performed, the reason for leaving, eligibility for rehire, performance, educational institutions, degree obtained, transcripts.

Drug and Alcohol Testing Disclosure: White River Academy is a drug and alcohol-free workplace. We do perform random drug testing. All employees may be subject to alcohol and/or drug testing if there is reasonable suspicion as determined by management and/or your supervisor. With any work-related accident, an alcohol/drug test is required. Prescription Marijuana and Opioids are also prohibited at White River Academy. Any employee requiring the use of these medications for any purpose will need to provide a doctor's note indicating the need and the duration of the need. Any employee taking these substances will be required to take an FMLA unpaid medical leave while taking these substances. Failure to do so might be cause for immediate termination of employment. These substances are not to be consumed in conjunction with working a shift at White River Academy. The above-mentioned substances may impair an employee's ability to adequately perform the job duties required thus putting the employees and clients in a situation of unnecessary risk.

Requirements: If hired, you will be required to read all manuals and abide by all guidelines and policies that White River Academy has in place. You will also be required to provide a current CPR & FIRST AID certification, cleared TB test results, and pass a BCI (Background Check). There will be multiple other required training that will be required. The employee's responsibility is to provide these items as often as required.

All White River Academy employees are required to be able to understand the verbal, non-verbal, and written communications of the clients and other employees.

All White River Academy employees who work in direct proximity of the clients must complete and be certified in Positive Control Systems. (Or any other applicable system that may be incorporated.)

White River Academy is an at-will employer. The Company or the employee can terminate the employment at any time and for any reason, with or without notice.

I acknowledge that I have read this authorization, fully understand it, and voluntarily agree to its provisions as I have indicated with my signatures.

I certify that I have completely and honestly answered all the above questions and consent to all of the mentioned arrangements.

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Once completed, please click submit for your application to be sent direct to
our team for review.