ZOKHA Autism Center (ZAC LLC)

Employee Application Form

“Where Care Meets Community”

148 Valley Hill Rd, Suite E · Riverdale, GA 30274 · info@zac-llc.org · 470-620-1522

Applicant Information
Position Applying For
Select the position(s) you are interested in and share your availability.
Work Eligibility
ZAC is required to verify that all employees meet legal work requirements.
Legally authorized to work in the U.S.?
Will you now or in the future require sponsorship?
Have you ever been convicted of a felony?
Education
Certifications (check all that apply):
Work Experience
Please list your most recent positions. You may also attach a résumé at the bottom of this form.
Employer 1 (Most Recent)
Employer 2
Employer 3
Autism Experience
Availability
Please share when you are typically available to work.
Days Available:
Preferred Shifts:
References (Non-Family)
Please list at least two professional or character references who are not family members.
Reference 1
Reference 2
Reference 3
Résumé / Additional Documents
Authorization & Acknowledgement

By submitting this application, I certify that the information provided is true and complete to the best of my knowledge. I authorize ZOKHA Autism Center (ZAC LLC) to verify any information contained in this application and to conduct background and reference checks as needed. I understand that any false or misleading information may result in disqualification from employment or termination if already hired. I understand that employment with ZAC is at-will.