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Contact

Application for Employment

Personal Information

Prefix

First Name

Middle Name

Last Name

Email Address

Phone *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Are you a U.S. Citizen or Alien authorized to work in the United States: *YesNo

Have you ever been employed by Ultimate Support Services, Inc? *YesNo

If yes, which office?

Position Held

How were you referred to the organization?

Which cities are you available to work in? *

How far are you willing to travel for work?

What hours or shifts are you interested in?

Education History

Background

Name/Address of School

Course of Study/Major

# of Years Completed

Did you graduate?YesNo

Indicate type of Degree or Diploma (BA, BS, MS, etc)

Licenses

License/CertificationList any licenses (including driver’s), certificates, registrations or professional associations which relates to, or is a requirement of, the position for which you are applying.

Employment HistoryEmployment History - Please give accurate, complete full-time and part-time employment record, beginning with your present or most recent employer. You may attach your resume.

Company Name *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone Number

Email Address *

Supervisor's Name

Position

Ending Salary

Dates of of Employment

Reason for leaving?

Job Responsibilities

May we contact this employer for a professional reference?YesNo

Professional References

Please list a minimum of three (3) professional references. Do NOT list personal references

Reference #1

First Name *

Last Name *

Title *

Company Name & Address *

Phone Number *Please enter a valid phone number.

Email Address *example@example.com

Confirm Email Address *

Reference #2

First Name

Last Name

Title

Company Name & Address

Phone NumberPlease enter a valid phone number.

Email Addressexample@example.com

Confirm Email Address

Reference #3

First Name

Last Name

Title

Company Name & Address

Phone NumberPlease enter a valid phone number.

Email Addressexample@example.com

Confirm Email Address

Have you ever been terminated from, or disciplined by, a previous employer for abuse or neglect *YesNo

If yes, please explain

Have you ever been convicted of a crime which has not been annulled, expunged, or sealed by a court?YesNo

If yes, please explain

The information provided on this Application for Employment is true, correct, and complete. It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or termination from employment if I am subsequently employed.

I give Ultimate Support Services the right to investigate all references and to secure additional information about me, including criminal background clearance, child abuse clearance, FBI clearance, motor vehicle records, etc. as deemed necessary and appropriated by the company for the position(s) for which I am applying. I hereby release from liability Ultimate Support Services, INC. and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information. Ultimate Support Services is an Equal Opportunity Employer.

Please Upload Your Resume

No file chosen

Consent *

Confirm that the information provided is true and accurate.

USS Ultimate Support Services, Inc. is dedicated to empowering individuals with developmental disabilities across Central, Western, and Southern Maryland. We don’t just care beyond limits; we support every journey.