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Employment Application
Southern Illinois Living Centers, dba Clinton Manor Living Center
Southern Illinois Community Support Services
300 E. Illinois St.
New Baden, IL 62265
We are an Equal Opportunity Employer. Applicants will receive consideration without discrimination based on race, color, creed, religion, sex, national origin, age, disability, marital or veteran status, sexual orientation or any other legally protected status.

Complete all sections of the application; if any spaces are incomplete you may not be considered for employment.
First: *
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Last: *
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Street Address: *
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City: *
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State: *
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Zip Code: *
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Phone 1: *
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Phone 2:
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Email Address: *
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Social Security Number:
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Are you 18 years of age or older? *
If under 18 years of age, can you, after employment, submit a work permit?
Have you ever worked for Southern Illinois Living Centers, Inc., Clinton Manor Living Center, or Southern Illinois Community Support Services? *
If yes, when?:
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