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Employment Application

Encompass Community Supports > Careers > Employment Application

Employment Application

Encompass Community Supports is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, religion, sex, national origin, handicap, age, or any other protected category.

If you have a disability which may require an accommodation during the interview or while performing the duties of the position, please contact Human Resources at 540-825-3100 ext. 3216 so that your situation may be assessed in accordance with the American Disabilities Act (ADA).

The mission of our agency is to improve the quality of life of the individuals, families, and communities we serve by providing comprehensive high quality Behavioral Health, Intellectual Disability, and Aging services.

Our vision is to assist each member of our communities to achieve with dignity their highest potential for living satisfying, productive, and valued lives.
Employment Application Guidelines

To ensure your application may be given consideration, please follow these guidelines:
- An employment application is required for all positions. A resume cannot be submitted instead of an employment application.
- ECS-AAA will only consider applications for positions that are currently open.
- Separate applications are to be submitted for each job sought.
- Photocopied applications with original signature will be accepted for multiple jobs for which you may be applying, as long as each has a unique position title and its unique vacancy number.
- Please supply all requested information thoroughly and completely. All sections of the application form must be fully completed for the application to receive consideration. Please do not write “see resume”.
- Illegible or incomplete applications may not be considered.
- Each application must indicate a position title and position number to be accepted.
- Applications are accepted during normal office hours (Monday – Friday 8:30 AM – 4:30 PM), by mail at ECS, Attention: Recruitment, P.O. Box 1568, Culpeper, VA 22701, by submitting it online, or by fax to 540-829-5440.
If your address or phone number changes during the recruitment process, it is your responsibility to notify the Human Resources Department in writing. If you are selected for a position you may be subject to fingerprint based criminal history and Department of Social Services background checks, and to drug testing.

Thank you for your interest in employment with us.
Position Applying For*
Hidden
Vacancy No.
Social Security Number*
Last Name*
First Name*
MI
Your Email*
Phone Number*
Street Address*
City*
State*
Zip Code*
All other names by which you have been known:
Please list any relatives, by blood or marriage, currently working for the agency:
Are you legally eligible for employment in the United States? (You are legally eligible if you are a US Citizen, a noncitizen national of the US, a lawful permanent resident, or an alien authorized to work)*
- Yes
- No
Are you willing to accept employment which requires working:
Evenings*
- Yes
- No
Weekends*
- Yes
- No
Holidays*
- Yes
- No
Overnight*
- Yes
- No
Are you willing to accept employment which requires traveling?
Overnights*
- Yes
- No
During the Day*
- Yes
- No
Do you have a valid Virginia Driver’s License? (DMV transcript may be required at time of interview)*
- Yes
- No
Have you been convicted of a traffic violation in the last three years?*
- Yes
- No
If yes, list all:
Have you ever been convicted of a law violation(s) excluding offenses committed before your eighteenth birthday which were finally adjudicated in a juvenile court or under a youth offender law?*
- Yes
- No
If yes, list all:
Education
High School / GED Name
City, State
Degree Received
Major Course Work
College Name
City, State
Degree Received
Major Course Work
Graduate School Name
City, State
Degree Received
Major Course Work
Other School Name
City, State
Degree Received
Major Course Work
List current professional licenses, certificates or authorizations to practice a trade or profession:
Type
License Number
Expiration Date
MM slash DD slash YYYY
Granted by (Licensing Board)
List any other relevant courses or training you have completed that qualify you for this position with RRCS:
List any special skills you possess that you would like us to consider in evaluating your qualifications for this position:
List your computer skills, including all hardware and software you are familiar with:
Work Experience
List all positions you have held. Include both paid experience and any relevant volunteer experience. Start with your present position and work backwards in chronological order.
May we contact your present Supervisor?*
- Yes
- No
Previous Employers?*
- Yes
- No
If no to either of the above, please state reason:
Present or Last Employer*
Address (City, State)*
Telephone Number*
Your Title*
Supervisor’s Name*
Dates of Employment*
Reason for Leaving*
No. Employees Supervised*
Duties*
Employer
Address (City, State)
Telephone Number
Your Title
Supervisor’s Name
Dates of Employment
Reason for Leaving
No. Employees Supervised
Duties
Employer
Address (City, State)
Telephone Number
Your Title
Supervisor’s Name
Dates of Employment
Reason for Leaving
No. Employees Supervised
Duties
Employer
Address (City, State)
Telephone Number
Your Title
Supervisor’s Name
Dates of Employment
Reason for Leaving
No. Employees Supervised
Duties:
Use this space to provide us with any further job-related information that we should use in considering you for employment.
Professional References
List three work-related references (Ex: previous supervisors, co-workers, etc.) not related to you who can provide us with information concerning your qualifications for employment.
Name*
Company*
Phone Number*
Full Address*
Name*
Company*
Telephone Number*
Full Address*
Name*
Company*
Phone Number*
Full Address*
Resume
Please Attach Your Resume
Max. file size: 32 MB.
Applicant's Certification and Consent
I certify that the information provided on this application is true, complete, and accurate to the best of my knowledge without consequential omissions of any kind. I understand that misrepresentation of any fact may be cause for my disqualification from further consideration for the position applied for or may result in my termination if hired for the position. I consent to references and former employers being contacted regarding this application. You have my permission to obtain my college transcript and verify license, certificate or other authorization to practice a trade or profession.
Signature
Date of Signature*
MM slash DD slash YYYY
By checking 'I Agree' below, I am agreeing to the above certification and consent:*
- I Agree
Equal Employment Opportunity (EEO) Compliance Form
You are asked to voluntarily provide us with the information requested on this form. This information is requested for EEO Compliance only and will not be used in making any employment decisions. This information will NOT be kept with your application for employment. Unlawful discrimination on the basis of race, color, sex, age, national origin, religion, or disability is prohibited by Federal law. Your cooperation in returning this form with your application will be sincerely appreciated.
Position Applied For
Vacancy No.
Gender:
- Male
- Female
Ethnicity:
- Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race
- Not Hispanic or Latino
Race:
- White / Caucasian: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
- Black / African American: A person having origins in any of the black racial groups of Africa.
- Native Hawaiian or Other Pacific Islander: A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
- Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
- American Indian: A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
- Two or More Races: All persons who identify with more than one of the above five races.
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