Online Application

This form serves as interest for employment with Durand, Inc. and will aid us in obtaining a clear understanding of your qualifications to fill specific job openings. If approved for employment, you will be contacted to complete the application process at Durand's Executive offices. It is the policy of this organization to provide equal employment opportunity without regard to race, color, religion, sex, pregnancy, national origin, ancestry, citizenship, age, marital status, physical or mental disability, medical condition, veteran status or sexual orientation.

Area of Interest (required)

Direct Support ProfessionalDirect Support ManagementBehavior AnalysisNursing/HealthcareSpecial Ed TeacherAideSLPOTPTCorporateOther

Please write your Area of Interest if you selected "Other".

First Name (required)

Last Name (required)

Street Address (required)

City (required)

State (required)

Zip code (required)

Phone (required)

Your Email (required)

Highest completed level of education?

Do you hold a valid driver's license?
YesNo

Have you ever been convicted of a crime?
YesNo

If you answered yes to the above question, tell us why you were convicted:

If related to anyone in our employ, state name and department:

Please name anyone who has referred you:

Are you prevented from lawfully becoming employed in this country because of visa/immigration status?
YesNo

Can you perform the essential functions for the job, which you are applying either with or without reasonable accommodation?
YesNo

On what date could you start?

Are you employed now?
YesNo

Have you ever worked for Durand before?
YesNo

Have you ever applied to Durand in the past?
YesNo

How did you hear of this opening? (required)

Include a message to add additional information that will help us to further evaluate you as a potential employee: (optional)

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