Online Application

Thank you for your interest in Autism Services Center (ASC) as a prospective employer. Your interest in our agency and its mission is greatly appreciated. Please read the following before continuing the employment application process.

Autism Services Center is an Equal Employment Opportunity/Affirmative Action employer and is therefore subject to certain governmental record keeping and reporting requirements. Applicants, who voluntarily self-identify their race, color, sex, national origin and veteran's status, allow ASC the ability to comply with state and federal regulations.

The information gathered on this form, other than name and position for which you have applied, is for statistical and affirmative action purposes only and does not influence employment decisions. This page is separated from your application immediately upon being received, and will be kept confidential. The second half of this form is to be completed voluntarily.

Contact Information

Employment Information

*If applying for Direct Care Staff, please name the Autism Services Center employee who referred you to our agency. (If applicable)


*Employment is subject to verification of age

Name of Location of School Course of Study Yrs. Completed Graduate Degree/Diploma
High School

Please list two (2) professional references and one (1) personal reference.

Professional Reference 1

Professional Reference 2

Personal Reference

Previous Employment

Company 1

Company 2

Company 3

Work Availability

ASC requires each employee to be available to work a minimum of 24 hours weekly and 16 hours of weekend/overnight availability is necessary.

The following is a Voluntary Survey for EEO Statistical Purposes Only

Ethnic Group:

Additional Information

Please select yes or no to the following questions:

Disclaimer and Signature

It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation ofthis application and/or separation from the employer's service if I have been employed. Furthermore, I understand that just as Iam free to resign at any time, the Employer reserves the right to terminate my employment at any time, with or without causeand without prior notice. I understand that no representative of the Employer has the authority to make any assurances to thecontrary.I give the Employer the right to investigate all references and to secure additional information about me, if job related. I herebyrelease from liability the Employer and its representatives for seeking such information and all other persons, corporations ororganizations for furnishing such information.The Employer is an Equal opportunity Employer. The Employer does not discriminate in employment and no question on thisapplication if used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited bylocal, state, or federal law.This application is current for only six (6) months. At the conclusion of this time, if I have not heard from the Employer and stillwish to be considered for employment, it will be necessary to fill out a new application.All applications become the property of Autism Services Center and are maintained in agency file for a period of six (6) months.I certify that my answers are true and complete to the best of my knowledge.If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.