Employment Application

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Skills Unlimited, Inc.

Personal Information

First Name *

Middle Initial

Last Name *

Maiden Name

Current Street Address

Street/PO Box

City or town, state, and ZIP code

Email Address

Phone #:

Are you 18 years of age or older? *

Yes

Referred by:

What employment location are you applying for? *

Nevada

Joplin

Employment Desired

Position *

Direct Care

Assistant Manager

Manager

Other:

Status Desired *

Full-Time (40 hours)

Part-Time (29 hours or under)

PRN (on-call only)

Any

Salary Desired

Date you can start *

YYYY

Are you currently employed?

Yes

Clear selection

If you are currently employed, may we inquire of your present employer?

Yes

Clear selection

Have you ever applied to this company before?

Yes

Clear selection

Where?

Joplin, MO

Nevada, MO

Clear selection

When did you apply before?

Are you related to a current Skills Unlimited Employee?

Yes

Clear selection

If you answered "yes" to the question above, what is the name of the current employee to which you are related?

What hours are you available to work?

At Skills Unlimited, Inc. we have a variety of shifts available that run around the clock. Generally, our shifts from 8am-4pm, 4pm-12pm and 12pm-8am, though we also have many other shift variations. Please note below what days and what times you are available to work:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Comment on availability:

Education

Where did you attend High School?

How many years did you attend High School?

Do you have a High School diploma or GED? *

Yes

Where did you attend College, Trade or Business School?

How many years did you attend College, Trade or Business School?

Did you graduate from College, Trade or Business School?

Yes

Clear selection

What subjects did you study?

English, Psychology, Math, etc...

What degree or certificates did you earn?

General

Do you have any special study, research or training skills in any subjects? If so, please explain:

Please check any of the following training in which you are currently certified:

MANDT

CPR

First Aid

Medication Administration

None of these

Do you have a current Driver's License?

Yes

Clear selection

Driver's License expiration date:

Do you have current car insurance?

Yes

Clear selection

Car insurance expiration date:

Have you ever been employed before?

Yes

Clear selection

Have you ever been convicted of a felony? *

Yes

Work History

Please list info on the last four employers, starting with the most recent.

Employer #1 (most recent)

#1 Dates worked (from Month/Year to Month/Year)

Example: 4/2011 to 3/2015

#1 Name of Employer:

#1 Employer Address

#1 Employer Phone#

#1 What was your position and what duties did you perform?

#1 Salary

$10/hr

#1 Reason for leaving:

Employer #2

#2 Dates worked (from Month/Year to Month/Year)

Example: 4/2011 to 3/2015

#2 Name of Employer:

#2 Employer Address

#2 Employer Phone#

#2 What was your position and what duties did you perform?

#2 Salary

$10/hr

#2 Reason for leaving:

Employer #3

#3 Dates worked (from Month/Year to Month/Year)

Example: 4/2011 to 3/2015

#3 Name of Employer:

#3 Employer Address

#3 Employer Phone#

#3 What was your position and what duties did you perform?

#3 Salary

$10/hr

#3 Reason for leaving:

Reference #1 (Name/Phone Number)

Reference #2 (Name/Phone Number)

Reference #3 (Name/Phone Number)

Emergency Contact (Name/Phone Number) *

Signature *

Date *

YYYY

Submit

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