Request for Application – Cottonwood Incorporated

Name*

First Last

Phone*

Email

Are you over the age of 18?*

Yes
No

You must be 18 or older to work at Cottonwood, Inc.

Are you willing to submit to a drug screen and background check?*

Yes
No

A drug screen and background check are required to work at Cottonwood, Inc.

AVAILABILITY

Desired Schedule*

Choose the type of hours you are most interested in working

EDUCATION

Most Cottonwood positions require a HS diploma or GED

Highest grade completed in school:*

11 or less
GED
High School Diploma
Some College
Bachelor's Degree
Master's Degree

Do you have a valid driver's license?*

Yes
No

Many positions require a driver's license.

Have you had any moving violations in the last 5 years? (Including speeding tickets)*

Yes
No

Are you a closely involved family member or legal guardian of any individual who receives services or who may want to receive services from Cottonwood in the future?*

Yes, receives services now
Yes, wants services in the future
No

If YES, you may not be eligible for employment at Cottonwood due to potential conflict of interest.

Are you prevented from lawfully becoming employed in the USA because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment.*

Yes
No

Have you been convicted of a felony within the last 7 years? (Conviction will not necessarily disqualify an applicant from employment.)*

Yes
No

NOTE: This form is a request for an application - It is not an application. Click submit below to send us your request and we will follow-up by phone within 3 business days. At that point we will send you a link to the actual application by email.