Personal Information
Required fields are indicated by *
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Education
High School
College
Correspondence, Business, Trade, or Other School
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Employment
Please indicate a continued record of employment, beginning with your most recent position. Include what you have done for the last five (5) years, or from the time you left school.
Employer 1
Employer 2
Employer 3
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Miscellaneous
1. Best time to contact you...
*Disclosure of information will not necessarily bar you from consideration for employment and will only be considered in relation to specific job requirements. Age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into consideration. Under federal regulations, however, conviction of resident abuse, neglect or mistreatment or misappropriation of resident property will disqualify you from consideration for employment.
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References
List three (3) persons unrelated to you.
Reference 1
Reference 2
Reference 3
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Acknowledgment
I certify that the answers given on this application are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I hereby give MSLCC the right to make a thorough investigation of my past employment, education and activities and I release from all liability all persons, companies and corporations supplying such information. I release and indemnify MSLCC from and against any liability which might result from making such an investigation. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.
Missouri Slope Lutheran Care Center is a drug-free/alcohol-free workplace employer.
If I receive a conditional offer of employment, I understand I will be the subject of drug and alcohol screening and/or physical screening and evaluation, and I hereby consent to such screening and record checks.
In the event of employment, I understand I will be required to conform to the rules and regulations of MSLCC. I also understand that if employed, any employment will be at will and for no definite period. This means that my employment and compensation can be terminated, with or without reason or cause, and with or without notice, at any time, at the option of either MSLCC or myself. I also understand that upon employment by this facility there will be a four-month trial period. I will consent to receive the physical assessment as required by MSLCC.
An electronic printed name is intended and understood to be a signature.
Authorization to Release Employment Information
Having made application for employment with Missouri Slope Lutheran Care Center and desiring them to be informed as to my previous record and character, I hereby authorize Missouri Slope Lutheran Care Center to investigate my past record and to ascertain any and all information which may concern my record and character, whether same is of record or not, and release my present and past employers, and all persons whomsoever from any damage because of furnishing said information.
An electronic printed name is intended and understood to be a signature.
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