Employment Application

Preparing, empowering and supporting individuals with disabilities.

Employment Application

Online Application

Stone Belt is an equal opportunity employer and does not discriminate against applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, sexual orientation, disability, or veteran status.

Personal Information


Record of Conviction

(A conviction will not automatically disqualify you for employment. Factors such as date of conviction, seriousness and nature of the crime, and rehabilitation will be considered.)

Driving History

Employment History

List employment starting with your most recent position. Please give an accurate and complete record of all full/part-time employment in the space provided and account for all periods of unemployment. DO NOT write “see resume” or “see previous application.” This section must be filled out completely, or this application will not be processed.



I agree to submit to any lawful drug, alcohol, or another testing that may be required as a condition of employment or continued employment and understand that refusal to promptly submit and cooperate with such testing prior to or during the course of my employment will result in disqualification from consideration for employment or, if hired, termination.  I fully understand that if employed, any misrepresentation or omissions on this application or on any other Stone Belt record will result in dismissal, regardless of the date of discovery