ACS - Online Application

General Information

Personal
Name First: MI: Last: SSN: (at least the last 4)
Address: City:
State/Prov: Zip:
Home Phone: Alt Phone: Alt Phone Type:
E-Mail: Age if under 21:
Have you had any relative work at ACS before?:
Have you ever worked or applied at ACS before?:

Background Clearance
Since all positions are working with vulnerable adults or children and require passing a background screening, do you have anything on your record which would cause you to fail the background check requirements as required by Medicaid, Federal and State laws (click here for more info, in general no felonies in the last 10 years, no class A or B misdemeanors in the last 5 and no child abuse or domestic violence convictions)?:
Comments:

Driving Record
Most positions require operating a motor vehicle, do you have a Valid Driver's License?
, State:
Do you have more than two moving violations in the past three years or restrictions or accidents in the past five years? ,
Explain:

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