Application for Employment

Equal Employment Opportunity Employer / Drug Free Workplace / E-Verify Participant

Application

Miami Lighthouse for the Blind and Visually Impaired, inc., is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, religion, ancestry, age, sex, marital status, national origin, disability or veteran status.

This application is valid for one year. Please answer all questions. Resumes are not accepted in lieu of the completion of this application.

GENERAL INFORMATION

Position applied for:  *
Date (mm/dd/yyyy):  *
First Name:  *
Last Name:  *
Address:  *
City:  *
State:  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   Zip Code:  *
Home Phone Number:  *
Alternate Phone Number: 
E-mail Address:  *
Salary Desired: 

Are you 18 years of age or older?  Yes No
Are you legally eligible for employment in the United States?  Yes No
(If offered employment you will be required to provide documentation to verify eligibility. Miami Lighthouse is a participant of the E-Verify Program. Posters are attached to this application.)

Are you able to perform the essential functions of the job for which you have applied, with or without reasonable accommodation?   Yes No  
If No, please explain:  
If Yes, please explain:  
How did you learn about our organization and/or position?:  

Upload Resume: 

APPLICANT'S CERTIFICATION AND AGREEMENT

Please read carefully before signing.

I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and I authorize Miami Lighthouse for the Blind to verify their accuracy and to obtain reference information on my work performance. I hereby release Miami Lighthouse for the Blind from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information.

I understand that misrepresentations, falsifications or omissions of facts requested in this application may remove me from further consideration for employment or withdrawal of any offer or employment. I understand that, if employed, misrepresentations, falsifications of any kind or omissions of facts called for on this application shall be considered sufficient basis for termination of employment at any time.

I understand that this employment application or the granting of an interview does not represent a contract of employment or a promise of future employment. I understand that should an employment offer be extended to me and I accept it, that I will fully adhere to the policies, rules and regulations of employment of the Miami Lighthouse for the Blind. However, I further understand that neither the policies, rules, regulations of employment nor anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that employment at Miami Lighthouse for the Blind is at-will and it may be terminated by either party at any time, for any reason, with or without cause or advance notice.

I understand that an employment offer will be contingent upon satisfactory outcome (as determined by Miami Lighthouse for the Blind in its sole discretion) of pre-employment screening processes which may include, but are not limited to the following: criminal background investigation, drug test, driving record, verification of education, verification of employment and reference check.

I understand that this application will remain active for one year as of the date of the application. If I wish to be considered for employment beyond one year I should complete a new application for employment.

I hereby acknowledge that I have read, understand and agree to the above statements.

Name of Applicant:  *
Initials:  *

E-Verify Participation

This Organization Participates in E-Verify®

This employer will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee’s Form I-9 to confirm work authorization.

IMPORTANT: If the Government cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact DHS and/or the SSA before taking adverse action against you, including terminating your employment.

Employers may not use E-Verify to pre-screen job applicants and may not limit or influence the choice of documents you present for use on the Form I-9.

To determine whether Form I-9 documentation is valid, this employer uses E-Verify’s photo matching tool to match the photograph appearing on some permanent resident cards, employment authorization cards, and U.S. passports with the official U.S. government photograph. E-Verify also checks data from driver’s licenses and identification cards issued by some states.

If you believe that your employer has violated its responsibilities under this program or has discriminated against you during the employment eligibility verification process based upon your national origin or citizenship status, please call the Office of Special Counsel at 800-255-7688, 800-237-2515 (TDD) or at www.justice.gov/crt/osc.

N O T I C E:
Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States.

E-Verify Works for Everyone
For more information on E-Verify, please contact DHS:
888-897-7781
www.dhs.gov/E-Verify

E-Verify is a service of DHS and SSA

The E-Verify logo and mark are registered trademarks of Department of Homeland Security. Commercial sale of this poster is strictly prohibited.

RIGHT TO WORK

Don’t let anyone take it away.

If you have the legal right to work in the United States there are laws to protect you against discrimination in the workplace.

You should know that –
• In most cases, employers cannot deny you a job or fire you because of your national origin or citizenship status or refuse to accept your legally acceptable documents.
• Employers cannot reject documents because they have a future expiration date.
• Employers cannot terminate you because E-Verify without giving you an opportunity to resolve the problem.
• In most cases, employers cannot require you to be a U.S. citizen or lawful permanent resident.

If any of these things have happened to you contact the Office of Special Counsel (OSC).

For assistance in your own language:
Phone: 1-800-255-7688 or (202) 616-5594

For the hearing impaired:
TTY 1-800-237-2515 or (202) 616-5525

E-mail: osccrt@usdoj.gov

Or write to:
U.S. Department of Justice – CRT
Office of Special Counsel – NYA
950 Pennsylvania Ave, NW
Washington, DC 20530

U.S. Department of Justice
Civil Rights Division

Office of Special Counsel for Immigration-Related Unfair Employment Practices

www.justice.gov/crt/about/osc