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Clausen House
Providing housing, wellness programs and advocacy for developmentally disabled adults in Oakland and East Bay area
Clausen House
  • About
    • About Clausen HouseOur mission and history
    • LeadershipExecutive Leadership, Program Directors, Board, Advisory Board
    • Community PartnersOur funders and sponsors
    • Ways to Give
    • TestimonialsWhat they are saying
  • Services
    • Adult EducationDay program and community center
    • Supported EmploymentEmployment assistance program
    • Independent and Supported LivingPerson-centered living services
    • Affordable HousingLenox apartment complex
    • Residential ServicesQuality group-home living
    • Health ServicesHealth-related services for our clients
    • AccreditationLearn about our accreditations
  • Careers
  • Resources
    • Coronavirus Resources
    • DDS/RCEB Resources
    • Additional Resources
  • Events
    • Upcoming EventsWhat’s coming up at Clausen House
    • NewsUpdates and information
    • Previous EventsView Clausen House previous events
  • Art Gallery
  • Shop
  • Contact
  • About
    • About Clausen HouseOur mission and history
    • LeadershipExecutive Leadership, Program Directors, Board, Advisory Board
    • Community PartnersOur funders and sponsors
    • Ways to Give
    • TestimonialsWhat they are saying
  • Services
    • Adult EducationDay program and community center
    • Supported EmploymentEmployment assistance program
    • Independent and Supported LivingPerson-centered living services
    • Affordable HousingLenox apartment complex
    • Residential ServicesQuality group-home living
    • Health ServicesHealth-related services for our clients
    • AccreditationLearn about our accreditations
  • Careers
  • Resources
    • Coronavirus Resources
    • DDS/RCEB Resources
    • Additional Resources
  • Events
    • Upcoming EventsWhat’s coming up at Clausen House
    • NewsUpdates and information
    • Previous EventsView Clausen House previous events
  • Art Gallery
  • Shop
  • Contact

Employment Application Form

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  2. Employment Application Form

"*" indicates required fields

We are an Equal Opportunity Employer

MM slash DD slash YYYY
Name*

Present Address

Address*

Employment Desired

Personal Information

Have you ever applied to or worked for Clausen House before?*
Do you have a valid CA Drivers license?*
Do you have at least the minimum amount of automobile insurance required by California Law?*
If hired, would you have a reliable means of transportation to and from work?*
Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age.)*
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?*
(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests.)

Education, Training, and Experience

High School

Did you Graduate?
Address

College/University

Did you Graduate?
Address

Vocational/Business

Did you Graduate?
Address

Certification

Did you Graduate?
Address

Employment History

List below all present and past employment starting with your most recent employer (last five years is sufficient). You must complete this section even if attaching a resume.

Address
Dates of Employment:
Current Employer?
May we contact this employer for a reference?
Address
Dates of Employment:
May we contact this employer for a reference?

References

List below three persons not related to you who have knowledge of your work performance within the last three years.

Name
Address
Name
Address
Name
Address

Please Read Carefully, Check Each Paragraph and Sign Below

Consent
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
Consent
I hereby authorize Clausen House to thoroughly investigate my references, work record, education and other matters related to my suitability for employment .I further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
Consent
I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the Company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the Company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the Company's designated representative.
Consent
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.
The Company will consider qualified applicants, including those with criminal histories, in a manner consistent with state and local "Fair Chance" laws.
MM slash DD slash YYYY

Employment Data Record

Employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or disability or any other legally protected status. As an employer with an Equal Opportunity Program, we comply with government regulations, including Equal Opportunity responsibilities where they apply.

The purpose for this Data Record is to comply with government record keeping, reporting, and other legal Requirements. Periodic reports are made to the government on the following information. The completion of this Data Record is optional. If you choose to volunteer the requested information, please note that all Data Records are kept in a Confidential File and are not a part of your Application for Employment or personnel file. Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.

Voluntary Survey

MM slash DD slash YYYY
Check One
Check one of the following (Ethnic Origin)
Check if any of the following are Applicable:
Our Mission

The Clausen House mission is to create opportunities for adults with intellectual and developmental disabilities to gain competency, identify and realize their goals and aspirations, develop relationships and join the community with increasing command over their own lives.

Contact
  • Jaynette@clausenhouse.org
  • 88 Vernon Street | Oakland CA 94610
  • (510) 839-0050

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