Phoenix NPIC Application Fillable 2015

7/24/2019 Phoenix NPIC Application Fillable 2015

1/8G:\Marketing\Public Relations\Affirmative Businesses Information\Business Services\NPIC\Phoenix Site\Phoenix Hiring Flier.12.201

Position Details

Customer Service Representatives

(Contact Center, no cold calls, no sales)

Pay starting at $12.53 per hour

Plus an hourly Health & Welfare Benefit

$4.27 per hour

Six days a week operation (Mon. -Sat.)

Full and Part-Time jobs available

Provide support by phone to answer

quesons about policies, pracces,

procedures and other data to assist callers

To Apply You Should

Be a person with a disability

Be a U.S. citizen

Pass a federal background check

Have a high school diploma or equivalent

Contact center experience is a plus,

customer service experience desired

How to Apply

Visit our website to apply on line. We will

contact you to schedule an in-person

interview.

You may also submit your resume and cover

letter [email protected]

People with disabilities and veterans areencouraged to apply, and will be given

preference in the hiring process.

For more information, visit

www.peckham.org.

For more information contact

Elizabeth O Rourke

at 480.400.5003 [email protected]

13450 N Black Canyon Hwy, Suite 200

Phoenix, AZ 85029

Full time available

$12.53 per hour,Plus a $4.27 Health&Welfare Benefit

You can apply online by visiting

www.peckham.org

Peckham Business Services

Incoming Call Center Jobs for People with

Disabilities in Phoenix, AZ

Peckham is an Equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals wit

disabilities.
mailto:[email protected]:[email protected]:[email protected]://www.peckham.org/http://www.peckham.org/mailto:[email protected]:[email protected]:[email protected]:[email protected]://www.peckham.org/mailto:[email protected]


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13450 N. Black Canyon Highway

Suite 200

Phoenix, AZ 85029480-400-5027

Welcome to Peckhams Employment Services

Thank you for your interest in Peckham.

We are a community rehabilitation organization, providing employment opportunities forpeople who have a documented disability or other identified vocational barrier. In order to

qualify for employment and training programs at Peckham, program participants must have a

significant disability and be unable to independently obtain and maintain employment in acompetitive environment due to limitations in work skills, work tolerance, communication,

mobility, and/or self-care as a result of a documented disability.

Please pay special attention when completing the Eligibility for Services section of this

application. Information you provide on these two pages will help determine if you are eligiblefor training and employment at Peckham.

You will be asked to provide documentation of your disability from a qualified professional

(physician, psychologist, or psychiatrist). We request that you bring this documentation to yourinterview, if possible. The Intake Specialist will describe additional program requirements

during your interview.

Due to the high volume of applications we receive, we are unable to

call back every applicant. If, after reviewing your information, you

appear to be eligible for Peckham services and you are selected to

move forward in the hiring process, we will call you for an interview.

Erase Data


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Service Application for Peckham Programs

Name

Street Address City, State, Zip

Telephone Number Alternate Number

What kind of position are you applying for? Call Center

Have you ever been employed by Peckham? Yes No

If yes, Location Dates of Employment

Reason for leaving Name employed under(If different now)

Are you 18 years of age or older? Yes No

If under 18, applicant will be required to submit a birth certificate or a work certificate as required by State or

Federal laws.

Can you, after employment, submit verification of your legal right to work in the United States? Yes No

Do you have a Social Security Administration Ticket to Work?

Yes

NoEmployment Source: Former Employee Walk-in Flyer School / College Other

Agency Referral: Name of Agency

Name of Counselor ______

US Military

Branch of Service Date Entered

Date Discharged Highest Rank

Do you have service-related skills and/or experience applicable to civilian employment? Yes No

If yes, describe

GeneralWhat additional relevant experiences or training have you had other than your work experience, military service

and/or education? Activities - civic, athletic, fraternal, etc. (Exclude organizations which indicate race, religion,

color or national origin of members.)

Have you ever been convicted of a felony? Yes NoHave you ever been convicted of any type of theft, fraud or a violent crime? Yes No

Availability

Do you prefer: Part-Time Full-Time

Check if you are available to work: Saturday Sunday

Shift Hours: Our National Passport Information Center hours of operation are 5:00am to 8:00pm - Monday

through Friday. Are you available to work anytime between these hours? Yes No

If No, what days and hours are you availableto work? ___________________________________________

EEO

An equal opportunity employer/program auxiliary aids and services are available upon request to individuals with disabilities


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Employment Background

List below your three most recent employers, beginning with the current or most recent (If you have had less

than three employers use the remaining spaces for personal references). If you were employed under a maidenor other name, please enter that name in the right hand margin.May we contact your present employer? Yes No

Most recent first:

Company Name Address

Job Title Name of Supervisor Phone

Date Started Date Left Base Salary or WageMonth/Year Month/Year

Reason for leaving




Reason for leaving




Reason for leaving

List 2 people (no relatives) you have worked with and whom we may contact for a reference if necessary.

Name: Name:Occupation: Occupation:

Phone Number: Phone Number:

Street: Street:

City, State, Zip: City, State, Zip:

We are glad you are interested in joining Peckham. Please read the following statements carefully before yousign and return this application.

The company, in considering my application for employment, may verify the information set forth on this

application and obtain additional background information relating to my background. I authorize all persons,

schools, companies, corporations, credit bureaus and law enforcement agencies to supply any informationconcerning my background. I have read, understand and agree to this statement (Please initial here) ________

I certify that the information on this application is correct and I understand that any misrepresentation oromission of any information will result in my disqualification from consideration for employment or if

employed, my dismissal. I have read, understand and agree to the statement above (Please initial here) ______

I understand that this application is good for sixty (60) days from todays date. If I still desire a position with

the company after this application expires, it will be my responsibility to fill out a new application and file it

with the company.

Date of Application Signature

(As shown on Social Security card)


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Release for Security Check

I, , authorize Peckham, Inc., the State of Arizona, and/or the

federal government to do a background security check for the purpose of employment at Peckham. Thesechecks may be run annually or more frequently due to probable cause.

Please Print

*Full Name: (last, first, middle initial)

*Drivers License Number or State of Arizona ID#:

*Date of Birth:

*Address: (City, State, Zip)

*Fields marked must be filled out

Signature of Applicant or Legal Guardian Date

EEO

An equal opportunity employer/program, auxiliary aids and services are available upon request to individuals

with disabilities.

Headquarters Location:

Peckham, Inc.

3510 Capital City Blvd,

Lansing, MI 48906-2102


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Eligibility for Services

The information requested on this form will be used to assist in determining your qualifications forvocational programs at Peckham. All information will remain confidential. To be eligible for most

programs at Peckham, it is necessary to provide a medical doctor or psychologists documentation of a

current medical, mental/emotional or substance abuse concern. If you have any questions regarding your

eligibility for services at Peckham, please contact Elizabeth O'Rourkeat

480-400-5027.

Applicants Name: Date:

Please state your diagnosis:

Please check all medical conditions for which you are currently receiving treatment:

Cancer Carpal Tunnel Syndrome Degenerative Disc Disease

Diabetes Emphysema Fibromyalgia

Traumatic Brain Injury Impaired Mobility Kidney Disease Liver Disease Loss of Limb Obesity Seizure Disorder Severely Impaired Hearing

Severely Impaired Vision Stroke Other:

Please check all limitations which you are currently facing due to your medical condition(s):

Standing Sitting Walking

Lifting Fatigue/Weakness

Difficulty Concentrating Impaired Memory Tolerance to Temperature Changes Tolerance to Environmental Changes (Gas, Fumes, Air Quality) Pain and/or Headaches Other:


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Eligibility for Services, continued

Please check any emotional or mental health concerns you may have:

Are you currently being treated by a psychiatrist, mental health therapist, or counselor?

Have you ever been told by a doctor or therapist that you were depressed, anxious, suicidal, bipolar or

schizophrenic?

Are you currently taking medication for depression or anxiety, such as: Zoloft, Paxil, Prozac, Celexa,

Lexipro or Xanax, Ativan, Serax, Clozaril, Serentil, Lithium, Eskalith, Lithane, Tegretol or Depakote?

Were you enrolled in special education classes while in school?

If yes, please state the reason you received special education services:

Have you ever been diagnosed with Adult Attention Deficit Disorder?

Are you taking medication for ADD or ADHD, such as Ritalin, Strattera or Adderal?

Are you currently receiving treatment for substance abuse?

Yes No

If you answered yes, is the treatment for:

Alcohol abuse Other drug abuse

Are you taking medication to treat substance abuse?

Yes No

Please list any other information you feel would be helpful in determining your eligibility for services:


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Relatives or Close Relationships of Peckham, Inc.

Applicant Disclosure

It is not unusual in large companies for employees to be relatives of, or to have close relationships with,

applicants who apply for positions in all areas of a company. We here at Peckham, Inc. have found that these

situations may, at times, be troublesome for the new employee and also for the company. In addition toproblems with perceived favoritism and claims of partiality in treatment, problems away from the work

environment can be carried over into day-to-day working relationships.

The criteria for employment at Peckham, Inc. of relatives and close relationships has always been to hire

applicants that meet the job-related skills, qualifications, and in the opinion of Peckham, do not create a conflictof interest. We do not hire nor reject an applicant based upon relationship status. We do, however, take steps to

assure placements are in appropriate departments and positions. You must disclose, in writing to Human

Resources, if you have any relatives and/or close relationships with Peckham, Inc. employees before we make

any job offer with our company. This disclosure must be submitted and approved by the Human ResourceDepartment. Any job offers made without this approval are not valid.

State the name and relationship of the person(s) you disclose as working at Peckham, Inc:

Name: Relationship:

No relationships to disclose: (check here)

Applicant Signature: Date:

Print your name:

Documents

Phoenix NPIC Application Fillable 2015