Senior Employment Program Application

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SEP Application

Application for the Senior Employment Program

Step 1 of 2

  • Certain information is collected for the purpose of reporting to funding sources.

    Applicants who are age 55 and older will be considered for placement opportunities without regard to race, color, religion, sex, national origin, marital status, veterans’ status, disability or other legally protected status. Responses to the following questions, together with information received from references or background checks, will not be used as a basis of discrimination but will be judged on the relevance of the information to the placement you seek.
  • MM slash DD slash YYYY
  • Individuals with certain felony convictions are not permitted to be employed in private homes. The employer reserves the right to conduct criminal background checks.
    (Please check one or both)
  • Reference information must be accurate and complete for the Senior Employment Staff to conduct appropriate screenings. Please fill out as completely as possible.
  • MM slash DD slash YYYY
  • For Senior Employment Staff Only:

  • MM slash DD slash YYYY