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Employment application

Complete the six-step application below. You can save your progress and return later.

Step 1 of 6

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URL

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Your Personal Information

It is the policy of Quiñcea Inc. to provide equal opportunity in employment. Selection and employment of applicants shall be made on the basis of their qualifications, without regard for disability, national origin, race, color, religion or sex.

The entire hiring packet can also be downloaded here.

Your Name

First Last

Your Email Address

Enter Email Confirm Email

Address

Street Address City State ZIP Code

Your Phone

Best Time To Call You

Position You're Applying For

HCBS

DTA

VOC

Desired Schedule

Full Time

Part Time

Seasonal

Split Shift

Hours You Are Available for Work

Please tell us what hours you are available for work each day of the week.

Monday

Tuesday

Wednesday

Thursday

Friday

Do you have a valid driver's license?

Yes

Driver's License Information

Driver's License Number

State

Expiration

Have you ever been employed with Quincea?

Yes

Explain previous employment

What was your reason for leaving?

How did you hear about us?

Friend

Flyer

Website

Newspaper

Employee

Other

Explain how you heard about us

List names or any other relevant information for how you heard about us.

Previous Employment

Your Previous Employers

Please list your previous employers, the dates you worked and the position you held

Employer

Dates

Position

Phone

More About You

Are you fluent in any other languages? (please specify)

Have you ever been employed under another name?

Yes

If yes what name did you use?

Applicant Education

Enter Education History

Institution Name

Location (City/State)

Degree/Diploma

Major

Number of Credits

Work History

Start with your most recent employer

Company Name

Address

Supervisor

Phone

Dates of Employment

Job Title

Duties

Tell Us About Yourself

Upload Your Resume

Upload your resume in .pdf, .doc or .docx format

Accepted file types: pdf, doc, docx, Max. file size: 25 MB.

Applicant Emergency Information:

Insurance

Company

Policy Number

Address

Phone Number

Emergency Contacts

Name

Relation

Address

Phone Number

The information requested below is requested for a legally permissible reason. Quiñcea Inc., does not discriminate in its employment practices based on race, age, color, gender, ethnic group, national origin, religion, citizenship, marital status, sexual orientation, veteran status, medical condition, physical or mental disability.

Are you 18 years or older?

Yes

Do you have the legal right to work in the United States of America?

Yes

Can you obtain three letters of recommendation?

Yes

To the best of your knowledge, are you able to pass a fingerprint clearance?

Yes

Terms and Conditions(Required)

Please read before you sign:
1. I understand that Quiñcea employees are fingerprinted and need to be cleared by DES Office of Investigations and Department of Public Safety.

2. If accepted, l agree to be governed and abide by all Quincea rules and regulations.

3. I authorize inquiry with regard to my character, ability, and habits of any and al persons, and agree to hold such person harmless with
respect to any information that they may give.

4. I certify that all answers to the questions on this application are true and I understand that any misstatement or omission of facts may
disqualify me or be cause for dismissal.

5. I understand that any employment offered is for an indefinite duration, at will, and that Quificea Inc. may terminate my employment at
any time with lawful cause.

I agree to the terms and conditions.

Digital Signature

Today's Date

MM slash DD slash YYYY

STOP – Please make sure to fill out these forms and upload below prior to submitting the application.

The entire hiring packet can also be downloaded here.

Upload all employment forms here:

Drop files here or

Max. file size: 128 MB.