Independent Living, Inc.

Text Size:

  • Facebook
  • Twitter

608.274.7900

HomeCareersJob Application

Employment Application

Equal access to programs, services and employment is available to all persons. Applicants requiring reasonable accomodation to the application and/or interview process should notify a representative of the Human Resources Department.

Fields marked with an asterisk (*) are required.

  1. Position(s) applied for:*
    Please enter what position(s) you are applying.
  2. Name:*
    Please enter your name.
  3. Address:*
    Please enter your address.
  4. City:
    Invalid Input
  5. State:
    Invalid Input
  6. ZIP:*
    Please enter a valid zip code.
  7. Telephone:
  8. Other Phone:
  9. E-mail:*
    Please enter a valid email address.
  10. How did you hear about us?
    Invalid Input
  11. Best time to contact you at home is:
    Invalid Input
  12. Are you currently employed?
    Invalid Input
  13. May we contact you at work?
    Invalid Input
  14. If yes, telephone number:
    Please enter a valid phone number.
  15. Best time to call:
    Invalid Input
  16. Previously employed by ILI?
    Invalid Input
  17. From:
    Invalid Input
  18. Until:
    Invalid Input
  19. Do any family members work at ILI?
    Invalid Input
  20. If yes, name(s):
    Invalid Input
  21. Are you legally eligible for employment in this country?*
    Please indicate if legally eligible to work in this country.
  22. Date available for work?
    Invalid Input
  23. Type of employment desired:*
    Please indicate type of work you are seeking (full time, part time, on-call, or any).
  24. Part Time Hours
    Invalid Input
  25. Days available:
    Invalid Input
  26. Shifts available:
    Invalid Input
  27. Have you ever been convicted of a crime?
    Invalid Input
  28. If yes, please explain:
    Invalid Input

    Conviction will not necessarily be a bar to employment. Each instance and explanation will be considered in relation to the position for which you are applying.

  29. If the position for which you have applied requires a vehicle, do you have a valid driver's license and can you provide us with a copy of your auto liability insurance?
    Invalid Input
  30.  

    Education


     

    High School
    Years Completed
    Graduated
    Invalid Input
    Invalid Input
    Invalid Input
    College/Technical School
    Years Completed
    Graduated
    Invalid Input
    Invalid Input
    Invalid Input
    Course/Major
    Degree
    		  
    Invalid Input
    Invalid Input
    		  
    From:
    Invalid Input
    To:
    Invalid Input
    		  
    Graduate School
    Years Completed
    Graduated
    Invalid Input
    Invalid Input
    Invalid Input
    Course/Major
    Degree/ Diploma
    		  
    Invalid Input
    Invalid Input
    		  
    From:
    Invalid Input
    To:
    Invalid Input
    		  
    Other Education
    Years Completed
    Graduated
    Invalid Input
    Invalid Input
    Invalid Input
    Course/Major
    Degree/Diploma
    		  
    Invalid Input
    Invalid Input
    		  
    From:
    Invalid Input
    To:
    Invalid Input
    		  
    Skills and Qualifications

    List any certificates, licenses, skills and special training to perform job related functions in the position for which you are applying.
    Invalid Input
     
     

    Work History


     

    Start with your present or most recent job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which would indicate religion, gender, national origin, disabilities, or other protected status.
    Company Name
    From:
    Until
    Your Title
    Starting Salary
    Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
    Company Street Address
    Telephone
    Supervisor
    Final Salary
    Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
    City and State
    ZIP
    Reason for Leaving


    Invalid Input
    Invalid Input
    Please enter a valid Zip.
    Invalid Input
    Your Specific Duties
    Invalid Input
    Company Name
    From:
    Until
    Your Title
    Starting Salary
    Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
    Company Street Address
    Telephone
    Supervisor
    Final Salary
    Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
    City and State
    ZIP
    Reason for Leaving


    Invalid Input
    Invalid Input
    Please enter a valid Zip.
    Invalid Input
    Your Specific Duties
    Invalid Input
    Company Name
    From:
    Until
    Your Title
    Starting Salary
    Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
    Company Street Address
    Telephone
    Supervisor
    Final Salary
    Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
    City and State
    ZIP
    Reason for Leaving


    Invalid Input
    Invalid Input
    Please enter a valid Zip.
    Invalid Input
    Your Specific Duties
    Invalid Input
    Company Name
    From:
    Until
    Your Title
    Starting Salary
    Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
    Company Street Address
    Telephone
    Supervisor
    Final Salary
    Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
    City and State
    ZIP
    Reason for Leaving


    Invalid Input
    Invalid Input
    Please enter a valid Zip.
    Invalid Input
    Your Specific Duties
    Invalid Input
     

    References


     

    Please list three work, volunteer or school references not previously listed
    Name
    Company Name
    Telephone
    Invalid Input
    Invalid Input
    Please enter a valid telephone number.
    Position or Title
    Relationship
    		  
    Invalid Input
    Invalid Input
    		  
    Name
    Company Name
    Telephone
    Invalid Input
    Invalid Input
    Please enter a valid telephone number.
    Position or Title
    Relationship
    		  
    Invalid Input
    Invalid Input
    		  
    Name
    Company Name
    Telephone
    Invalid Input
    Invalid Input
    Please enter a valid telephone number.
    Position or Title
    Relationship
    		  
    Invalid Input
    Invalid Input
    		  
    I understand that any oral or written statement that is false, fraudulent or misleading that is contained in this application or attached materials will result in the rejection of my application, denial of employment and/or termination, if discovered after employment.
    • I certify that all statements contained in this application are true and complete whether made by me or others at my request.
    • I understand that I must prove that I am authorized to work in the United States if I am hired.
    • I authorize my driving record to be checked if the position for which I am applying requires driving.
    • I understand that Wisconsin State Law requires a criminal justice check to be conducted for those who are employed in the role of a caregiver or driver
    • I authorize the release of information regarding my past employment as requested by Independent Living, Inc.
    Candidates selected for interviews will be asked to acknowledge the above statements by signing and dating the submitted application as part of the interview process.


    Your application will be kept active for a period of 60 days after it is received.

    Please enter the security code:
    Please enter the security code:
      
    If you can't read the characters
    in the picture above, click here    Please enter a valid security code.
     

2970 Chapel Valley Road, Suite 203
Madison, WI 53711-7424

Independent Living Phone: 608.274.7900
Independent Health Care Phone: 608.274.2097
Email