Apply for Support Coordinator - Volunteers of America South Central Louisiana

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Apply for Support Coordinator

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Summary
Title:	Support Coordinator
ID:	1852
Department:	Elderly & Disabled Adults
Employment Type:	Full Time
Pay Rate:	$18.97/hr or $39,457.60/yr
Location:	Shreveport, LA
Education:	4 Year Degree
Experience:	Less than a year
Licensure:	N/A
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Attachments
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Application for Employment

PERSONAL INFORMATION

* Are you legally eligible to be employed in the United States? (Proof of identity and eligibility will be required upon employment):

Yes No

* Are you at least 18 years or older? (If no, you may be required to provide authorization to work):

Yes No

* Have you ever been convicted of a felony or a misdemeanor which resulted in imprisonment within the last seven years? (A conviction will not necessarily result in the denial of employment):

Yes No

If Yes, please explain:

* Have you ever worked for this Company before?:

Yes No

If Yes, please provide details (Where/When/Job Title):

* Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?:

Yes No

If no, please explain:

EMPLOYMENT DESIRED

* When would you be available to begin work?:

* Type of employment desired:

Full-Time
Part Time
Seasonal

* Hourly rate/salary desired:

* Are you currently employed?:

Yes No

If so may we inquire of your present employer?:

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If presently employed, why are you considering leaving?:

EDUCATION

Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended.

School Name & Location	Did you Graduate?	Degree Received	Subjects Studied/Major
	Yes No
	Yes No
	Yes No

If you have completed any special courses, seminars and/or training that would help you to perform the position for which you are applying, please describe:

EMPLOYMENT HISTORY

Give your full employment record, starting with your current or most recent employment

EMPLOYER 1

Dates Employed	Employer Name & Address	Employer Phone
From: * To: *	* *	*

Job Title	Supervisor Name & Title	May we Contact?
*	* *	Yes No

Responsibilities	Reason for Leaving	Salary/Hourly Rate
*	*	Start: * End: *

EMPLOYER 2

Dates Employed	Employer Name & Address	Employer Phone
From: To:

Job Title	Supervisor Name & Title	May we Contact?
		Yes No

Responsibilities	Reason for Leaving	Salary/Hourly Rate
		Start: End:

EMPLOYER 3

Dates Employed	Employer Name & Address	Employer Phone
From: To:

Job Title	Supervisor Name & Title	May we Contact?
		Yes No

Responsibilities	Reason for Leaving	Salary/Hourly Rate
		Start: End:

REFERENCES Please provide three references (not relatives).

Name	Relationship	Phone Number	Email

AUTHORIZATION

The facts set forth in this application and any supplemental information are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be considered sufficient cause for immediate discharge. I hereby authorize investigation of all statements contained herein and employers listed above to give you any and all information concerning my employment, and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for the company to hire me. If I am hired, I understand that either the company or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of the company has the authority to make any assurance to the contrary.

I understand that I am required to abide by all rules and regulations of the company.

* Signature (type name):

* Date:

2023 - Voluntary Self-Identification of Disability CC-305

Voluntary Self-Identification of Disability

Form CC-305
Page 1 of 1

OMB Control Number 1250-0005
Expires 04/30/2026

Name:

Employee ID:

(if applicable)

Date:

Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?

A disability is a condition that substantially limits one or more of your "major life activities." If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:

Alcohol or other substance use disorder (not currently using drugs illegally)
Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
Blind or low vision
Cancer (past or present)
Cardiovascular or heart disease
Celiac disease
Cerebral palsy
Deaf or serious difficulty hearing
Diabetes

Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
Epilepsy or other seizure disorder
Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
Intellectual or developmental disability
Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
Missing limbs or partially missing limbs
Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports

Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)
Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
Partial or complete paralysis (any cause)
Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
Short stature (dwarfism)
Traumatic brain injury

Please check one of the boxes below:

Yes, I have a disability, or have had one in the past
No, I do not have a disability and have not had one in the past
I do not want to answer

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

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