Application
Grace's Place Crisis Nursery, Inc. Employment Application
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Position Applying For
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Your answer
First and Last Name
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Your answer
Maiden Name
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Your answer
Address
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Your answer
City, State, Zip
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Your answer
Phone Number
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Your answer
Email
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Your answer
Desired Starting Pay
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Your answer
Are you currently employed?
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Yes
No
Are you at least 21 years old?
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Yes
No
Name of High School
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Your answer
Which do you hold?
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High School Diploma
GED
College Diploma
Name of College
Your answer
Degree
Yes
No
In Progress
If you hold a degree, in what field? Or what degree are you in the process of obtaining?
Your answer
Additional Training, Membership or Skills
Your answer
Most Recent Employer #1 (Name)
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Your answer
Employers Address, City, State, Zip #1
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Your answer
Employers Phone Number #1
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Your answer
Dates Employed (From and To) #1
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Your answer
Reason for Leaving #1
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Your answer
May we contact Employer? #1
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Yes
No
Most Recent Employer #2 (Name)
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Your answer
Employers Address, City, State, Zip #2
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Your answer
Employers Phone Number #2
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Your answer
Dates Employed (From and To) #2
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Your answer
Reason for Leaving #2
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Your answer
May we contact Employer? #2
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Yes
No
Most Recent Employer #3 (Name)
Your answer
Employers Address, City, State, Zip #3
Your answer
Employers Phone Number #3
Your answer
Dates Employed (From and To) #3
Your answer
Reason for Leaving #3
Your answer
May we contact Employer? #3
Yes
No
Professional Reference Name and Phone Number #1
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Your answer
Professional Reference Name and Phone Number #2
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Your answer
Professional Reference Name and Phone Number #3
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Your answer
Have you ever been convicted of a crime other that a minor traffic violation?
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Yes
No
Grace's Place Crisis Nursery is open 24/7/365. Please select your availability preference
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Full Time
Part Time
Which Shifts?
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Days
Evenings
Weekends
Overnights
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
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By clicking this box, I acknowledge that I have read and agree to the above terms.
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.
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By clicking this box, I acknowledge that I have read and agree to the above terms.
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.
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By clicking this box, I acknowledge that I have read and agree to the above terms.
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.
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By clicking this box, I acknowledge that I have read and agree to the above terms.
Required
Date
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MM
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DD
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YYYY
Are you currently involved with any litigation matters with any current or previous employers?
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Yes
No
To be considered for the position all applicants MUST send a current resume to LHP@GracesPlaceCrisisNursery.com.
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