Man Using Magnified Text on His Computer to Easier Read the TextOnce you review a position for which you wish to apply click the Apply Now link following the job description. By clicking Apply Now, it will open CABVI’s Employment Application. One form serves as the application for all of our job openings.

CABVI Human Resources
507 Kent Street
Utica, NY 13501
Fax: (315) 797-2244
  • Mac users: You may need to save the PDF to your computer before opening it in Adobe Acrobat.

If you have questions please email julieb@cabvi.org.

Apply Now

CABVI is an Equal Employment Opportunity employer and welcomes all qualified applicants. Qualified applicants will receive fair and impartial consideration without regard to race, sex, color, religion, national origin, age, disability, veteran status, genetic data or any other legally protected status.

Application will remain on file for one year and interest in a position beyond this date will require completion of a new application.

IMPORTANT: Please type or print all requested information in its entirety,
including information that may already be listed on your resume.

POSITION APPLIED FOR:

DATE OF APPLICATION:

Check Which Apply:


PERSONAL DATA

First Name

Middle Initial

Last Name

Street Address:

City:

State:

Zip Code

Home Phone

Alternative Phone

Email Address

Are you over 18?

If not, do you have working papers?

Are you authorized to legally work in the United States?

When could you start work?

Have you been convicted of, or pleaded guilty or no contest to a felony?

(A conviction will not necessarily disqualify you from being considered as a candidate for
employment.) If “yes,” please explain in the comments section at the end.

If the position you are applying for involves evening or weekend work, can you fulfill such
scheduling requirements?

Are you willing to work additional hours as required?

Are you willing to travel as required?

Where did you find out information about our agency/job vacancy?


EDUCATION AND TRAINING
High School

Name and Address

Number of Years Attended

Degree or Diploma

College/University

Name and Address

Major

Number of Years Attended

Degree or Diploma

Name and Address

Major

Number of Years Attended

Degree or Diploma

Name and Address

Major

Number of Years Attended

Degree or Diploma

Certificates

Other

Are you studying now?

If yes, what and where?

Other training, experience, or activities job related

Do you have the ability to perform essential functions of the job? (a full job description is available from HR upon request)

Technical skills

Computer systems knowledge (check all that apply):

Certificates
PROFESSIONAL REFERENCES:

Name:

Title:

Company:

Phone #:

Name:

Title:

Company:

Phone #:

Name:

Title:

Company:

Phone #:


EMPLOYMENT HISTORY AND REFERENCES

List below your work experience (starting with your present or most recent employer) for the last ten years. Please account for any periods of unemployment. Include military service, internships, and relevant volunteer service.

Dates of Employment
From:

To:

Employer's Name, Address, and Phone Number:

Gross Annual Salary:

Positions Held:

Immediate Supervisor:

Reason for leaving:

Dates of Employment
From:

To:

Employer's Name, Address, and Phone Number:

Gross Annual Salary:

Positions Held:

Immediate Supervisor:

Reason for leaving:

Dates of Employment
From:

To:

Employer's Name, Address, and Phone Number:

Gross Annual Salary:

Positions Held:

Immediate Supervisor:

Reason for leaving:

UPLOAD YOUR RESUME


ACKNOWLEDGEMENT AND UNDERSTANDING:

I hereby affirm that the information provided in this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that falsified information or significant omissions may disqualify me and be considered sufficient justification for dismissal if discovered at a later date.

I understand that if employed, my employment is for no definite period of time and that I may terminate my employment relationship with the Central Association for the Blind and Visually Impaired (CABVI) at any time, for any reason, and that CABVI has the same right (Employment at Will). I also understand that no representative of CABVI has any authority to enter into any agreement contrary to the foregoing or make any assurance or promise of continued employment.

If employment is obtained under this application I will comply with all rules and regulations of CABVI, which I understand are subject to change from time to time by CABVI. I agree to be responsible for property and equipment issued to me by CABVI until returned to CABVI.

I understand that according to federal law all individuals must, as a condition of employment, produce certain documentation to verify their identity as a U.S. citizen, or if aliens, their legal authorization to work in the U.S.A. As a result, I understand that any offer of employment would be contingent upon my ability to produce the required documentation within the time period required by law.

I authorize investigation of all statements contained in this application for employment (and accompanying resume, if any) as may be necessary in arriving at an employment decision.

Electronic Signature of Applicant:
Please type your First and Last Name

Date:

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above ACKNOWLEDGEMENT AND UNDERSTANDING.

IF YOU HAVE ANY QUESTIONS OR COMMENTS, PLEASE ENTER THEM HERE

Electronic Signature of Applicant:
Please type your First and Last Name

Date:

I understand that checking this box constitutes a legal signature confirming that I wish to submit my application.

DEMOGRAPHIC INFORMATION ON APPLICANTS

CABVI is an Equal Opportunity Employer. As required by law, we must record certain information to be made a part of our Affirmative Action Program. Your voluntary responses will remain confidential within the Human Resources Department and will be used only for the necessary information to include in our Affirmative Action Program. Refusal to provide this information will have no bearing on your employment and will not subject you to any adverse treatment.

Please complete the information requested below. Thank you for your assistance.

Name:

Date:

Gender (Check One):

Ethnicity (Check One):

Race (Check all that apply):

VOLUNTARY SELF-IDENTIFICATION FORM:

Veterans

CABVI is an Equal Opportunity Employer. Providing the information requested in this form is voluntary and will assist us in maintaining affirmative action programs to promote employment opportunities of individuals who are special protected veterans and other protected veterans. Disclosure or refusal to provide such information will in no way result in adverse treatment. All information provided will be kept confidential.

Name:

Date:

Please indicate the category or categories that apply to you:

List any accommodations needed to assist you in performing the essential functions of your job:

Voluntary Self-Identification of Disability

Form CC-305
OMB Control Number 1250-0005
Expires 1/31/2017
Page 1 of 2

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:
• Blindness • Autism • Bipolar disorder • Post-traumatic stress disorder (PTSD)
• Deafness • Cerebral palsy • Major depression • Obsessive compulsive disorder
• Cancer • HIV/AIDS • Multiple sclerosis (MS) • Impairments requiring the use of a wheelchair
• Diabetes
• Epilepsy • Schizophrenia
• Muscular dystrophy • Missing limbs or partially missing limbs • Intellectual disability (previously called mental retardation)

Please check one of the boxes below:

Your Name

Today’s Date

Voluntary Self-Identification of Disability
Form CC-305
OMB Control Number 1250-0005
Expires 1/31/2017
Page 2 of 2

Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

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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