Crossroads Louisiana, Inc.
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Employment Application Form

Step 1 of 10

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  • Days and times available to work (PLEASE CHECK ALL THAT APPLY):
  • EDUCATIONAL INFORMATION

    Position requires High School Diploma, GED or 5 years experience in the field

  • High School details
  • College details
  • Business or Trade School details
  • Professional School details
  • Other education details
  • Employment History

    Please begin with your most recent jobs and list all jobs you have held.

    NOTE: If you have previously worked for either of our companies, be sure to provide that information below.

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  • YOU MUST COMPLETE THE FOLLOWING

    Crossroads Louisiana, Inc. is a progressive agency. We strive to emphasize each person’s abilities (not disabilities). We believe that each person we support is a unique individual with his/her own skills, interests, talents and resources. We believe that with support, every adult we serve is able to successfully live in the community.


    In 150 words or less, tell us below, how your unique talents and abilities can help us support the people we serve.
  • EMPLOYMENT INFORMATION
  • ADDITIONAL WORK/EMPLOYMENT SKILLS
  • TRANSPORTATION
  • REFERENCES

    Please provide the information requested below for 2 personal (friend, clergy, teachers, etc.) OR non-work/company references.

    NOTE:At least one reference MUST be a work reference. Your application may not be processed until this section is completed in full.

  • The information provided in this application and on the attached Reference Check forms are accurate and complete. I understand that if it is determined that the information I have provided is misleading, inaccurate, false or incomplete, I will not be hired. I further understand that my employment may be terminated if it is determined, after I am hired, that the information provided on this application is misleading, inaccurate, false or incomplete.

    If I'm offered a job with the Company, I understand that my employment will be at will and that no one has the right or authority to offer me employment for a definite term or duration.

    The Company is an Equal Employment Opportunity employer and does not discriminate on the basis of gender, race, age, disability, national origin, religion, veteran status or any other category protected under state or federal laws.

    I authorize the Company to conduct oral and/or written reference checks, Criminal Records Check, and drug testing as part of the application process

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  • To Whom It May Concern:

    I have applied for a job with Crossroads Louisiana, Inc. /Job Link Your cooperation in supplying Crossroads and/or Lob Link with the information requested below concerning my work record at your company would be greatly appreciated. I hereby release you and the company providing responses below from any and all claims of any type which I may or might have arising out of your completing this reference check form. My signature below is my authorization to release the information requested. Thank you in advance for your assistance in this matter.


    CRIMINAL RECORD CHECK FEE: As of July 1, 2013, the fee for Criminal Background Ckecjk is $46.00. This is authorization to deduct that amount from my paycheck following being hired.

    From: Crossroads La Inc. / Job Link Human Resources Deparment
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  • State Police Inquiry Authorization and Release

    In connection and for the duration (including contract for services) with Crossroads Louisiana, Inc./lob Link, Inc. , I understand that I am selecting to provide requested personal information to process a background and security check as a condition for potential employment. Background Research Solutions, LLC "BRS", an authorized agency, will obtain an investigative report maintained in the files of the Louisiana Bureau of Criminal Identification and Information within the Department of Public Safety and Corrections pursuant to LA R.S. 40:1203.2. Reported information will be in compliance with subsection 0(1) which states "The office or authorized agency shall provide to the employer only such information as is necessary to specify whether or not that person has been arrested for or convicted of or pled nob contendere to any crime or crimes, the crime or crimes for which he has been arrested or convicted or to which he has pled nolo contendere, and the date or dates on which the crime or crimes occurred". Follow up investigations may be made into Louisiana parish or local court records and/or court records of another state. Further, I understand that you may request information from various federal, state and other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil, medical exclusion and other experiences as well as claims involving me in the files of insurance companies.

    I hereby authorize and understand such investigation and further give permission to authorized law enforcement agencies and /or courts to release all criminal record information maintained in their files which may confirm or deny my employment eligibility. ''BRS" is only disseminating information requested and is not rendering or offering opinion on employment and/or permit eligibility.

    Your authorization releases Background Research Solutions, LLC an authorized agency, any law enforcement agency and/or court contracted by the authorized agency from all damages, of whatever type or nature, including court costs and reasonable attorney fees suffered by any person, including the undersigned, while investigating my criminal history.

    It is my understanding that the results of the investigation will remain confidential and that if any criminal history is found to exist, then I will be provided an opportunity to refute, correct, and/or otherwise clarify such information by conducting a right to review with Louisiana Bureau of Criminal Identification and Information within the Department of Public Safety and Corrections, Office of the State Police.

    I agree that any copy of this document is as valid as the original.
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  • This field is for validation purposes and should be left unchanged.

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Crossroads Louisiana

Crossroads Louisiana, a 501 (c)3 non-profit agency, was founded by Dr. Gerald Murphy in 1982 to serve persons with intellectual disabilities (ID) in the Greater New Orleans area. As more and more State institutions began to shut their doors, Dr. Murphy saw an urgent need to provide community-based services that maximize each individual’s potential for independent community living and self sufficiency.

 

Contact Information

3727 General DeGaulle New Orleans, LA 70114

504-366-1828

504-366-0727

info@crossroadsla.com

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