Grace's Place, Inc. Application for Employment
Please complete the following form for employment consideration.
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Position Applying For *
First and Last Name *
Maiden Name *
Address *
City, State, Zip *
Phone Number *
Email *
Desired Starting Pay *
Are you currently employed? *
Are you at least 21 years old? *
Name of High School *
Which do you hold? *
Name of College
Degree
Clear selection
If you hold a degree, in what field? Or what degree are you in the process of obtaining?
Additional Training, Membership or Skills
Most Recent Employer #1 (Name) *
Employers Address, City, State, Zip #1 *
Employers Phone Number #1 *
Dates Employed (From and To) #1 *
Reason for Leaving #1 *
May we contact Employer? #1 *
Most Recent Employer #2 (Name) *
Employers Address, City, State, Zip #2 *
Employers Phone Number #2 *
Dates Employed (From and To) #2 *
Reason for Leaving #2 *
May we contact Employer? #2 *
Most Recent Employer #3 (Name)
Employers Address, City, State, Zip #3
Employers Phone Number #3
Dates Employed (From and To) #3
Reason for Leaving #3
May we contact Employer? #3
Clear selection
Professional Reference Name and Phone Number #1 *
Professional Reference Name and Phone Number #2 *
Professional Reference Name and Phone Number #3 *
Have you ever been convicted of a crime other that a minor traffic violation? *
Grace's Place Crisis Nursery is open 24/7/365. Please select your availability preference *
Which Shifts? *
Required
This document serves solely as a clear and conspicuous written disclose as a required by Federal Fair Credit Reporting Act set forth in Section 6904(b) to the Applicant that previous employment, education, social security, credit, motor vehicle report and a criminal background check may be obtained for the purpose of this employment application only *
Required
I certify the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application, as well as information concerning me from my present (unless otherwise indicated by me) and former employers as may be necessary in arriving at an employment decision. *
Required
I authorize my employer or potential employer to investigate, obtain, compile, examine, copy or receive any records pertaining to my employment history and completely and without reservation allow my employer to release and/or discuss any information about my employment history with authorized personnel of the Department of Social Services. I further authorize the Department of Social Services to share any personal information that the Department of Social Services may have about me with my employer or prospective employers as the Department determines necessary to make personnel decisions regarding my suitability to provide services with my employer. By authorization of the above, I agree to hold harmless any individual, partnership, corporation, educational institution or agency. The Department of Social Services, the Missouri Children's Division, its officers, agents and employees, as well as the State of Missouri from any liability for any damage whatsoever for issuing such information. *
Required
This application contains no misrepresentation or falsifications and the information given within it is true and complete to the best of my knowledge. I am aware that should an investigation, at any time, disclose any misrepresentation or falsification, as to a material fact, my application will be rejected. If employment has already been extended, I understand I may be dismissed by the employer. *
Required
Date *
Are you currently involved with any litigation matters with any current or previous employers? *
To be considered for the position all applicants MUST send a current resume to info@GracesPlaceCrisisNursery.com.
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