Handishop Industries, Inc. - Rehabilitation Center and Adult Day Centers in Wisconsin
Handishop Industries, Inc. - Rehabilitation Center and Adult Day Centers in WisconsinHandishop Industries, Inc. - Rehabilitation Center and Adult Day Centers in WisconsinHandishop Industries, Inc. - Rehabilitation Center and Adult Day Centers in WisconsinHandishop Industries, Inc. - Rehabilitation Center and Adult Day Centers in Wisconsin

Handishop Industries

Application for Employment

Including Area Code If you wish to be contacted through email

Position(s) Interested In*

Type of Employment Desired*

Referral Source


It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer’s service if I have been employed. I give the Employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the Employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.

The Employer is an Equal Opportunity Employer. The Employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, state, or federal law.

This application will be kept on file for a period of two years and I will be considered for positions as they come available. At the conclusion of this time, if I have not heard from the Employer and still wish to be considered for employment, it will be necessary to fill out a new application.

I understand that just as I am free to resign at any time, the Employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the Employer has the authority to make any assurances to the contrary.

Employment History

Employer 1

Street Address/City/State/Zip

Employer 2

Street Address/City/State/Zip

Employer 3

Street Address/City/State/Zip

Educational Background


It is the policy of Handishop Industries to maintain and promote employment opportunities to all individuals without regard to race, handicap, gender, age, creed, or national origin and to promote that policy through a positive continuing program to be known as Handishop Industries Affirmative Action Program.

To help us comply with Federal/State equal employment opportunity record keeping reporting and other legal requirements, please answer the questions below.

Completion of this portion of the form is voluntary.

Race/Ethnic Group


Military Service

This Affirmative Action form will be kept in a Confidential File separate from the personal files.

Voluntary Self-Identification of Disability

Why are you being asked to complete this form?

We are a federal contractor or subcontractor required by law to provide equal employment opportunity to qualified people with disabilities. We are also required to measure our progress toward having at least 7% of our workforce be individuals with disabilities. To do this, we must ask applicants and employees if they have a disability or have ever had a disability. Because a person may become disabled at any time, we ask all of our employees to update their information at least every five years.

Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. Your answer will be maintained confidentially and not be seen by selecting officials or anyone else involved in making personnel decisions. Completing the form will not negatively impact you in any way, regardless of whether you have self-identified in the past. For more information about this form or the equal employment obligations of federal contractors under Section 503 of the Rehabilitation Act, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to:

  • • Autism
  • • Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS
  • • Blind or low vision
  • • Cancer
  • • Cardiovascular or heart disease
  • • Celiac disease
  • • Cerebral palsy
  • • Deaf or hard of hearing
  • • Depression or anxiety
  • • Diabetes
  • • Epilepsy
  • • Gastrointestinal disorders, for example, Crohn's Disease, or irritable bowel syndrome
  • • Intellectual disability
  • • Missing limbs or partially missing limbs
  • • Nervous system condition for example, migraine headaches, Parkinson's disease, or Multiple sclerosis (MS)
  • • Psychiatric condition, for example, bipolar disorder, schizophrenia, PTSD, or major depression

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