Employment Application

TWO Professional References

TWO Personal References

Employment Eligibility Verification I-9

NOTE: You are required to bring original unexpired employment eligibility documents for HR review during your scheduled appointment. Please refer to the “Acceptable List of Documents” on the I-9 Form.

OPWDD Statewide Central Register Database Check

NOTE: This form needs to be filled out completely. You must include the names and dates of birth for everyone currently residing in your household. Address history must go back 28 years (month/year format) dating back to 1995 with no gaps in time. If you are not 28 years old, provide addresses from your date of birth through your current address.

Notification of Social Services Law

Mental Hygiene Law 16.34 – Form 152

Fingerprint – Consent Form

Fingerprint – Registration Data

Fingerprint – Personal Criminal History Review

Federal Income Tax Form W4

NYS Income Tax Form IT-2104

Direct Deposit Form

NOTE: You must bring either a blank voided check (not a starter check) or a letter from your financial institution which includes your name, routing number and account number.

Personal Information/Emergency Contact Form