Woodhaven: Alternative Job Application

Alternative Job Application

If you had trouble submitting your application using our new form, please use this one to do so or you may contact us if you need any further assistance.

*Please note that if you navigate away from this page your work will not be saved.

General Information

* Name

* Last Name

Middle Initial

* Email

Please note:Email is our main form of communication during the initial application process.

Social Security Number

* Address

* City

* State

* Zip

* Home Phone

Cell Phone

* Position Desired

Shift Availability

Days Available Monday Tuesday Wednesday Thursday Friday Saturday Sunday

* Available At

* Available Until

* Are you currently employeed?

Yes No

* Date Available

* Minimum Pay Expected

How did you hear about us? Newspaper Radio Job Service College Posting Word of Mouth

Other Source

Woodhaven Employee

* Do you have a HS Diploma or GED?

Yes No

* Are you at least 18 years of age?

Yes No

* Are you legally authorized to work in the United States?

Yes No

* Are you elegible to obtain a Chauffer's License?

Yes No

If you answered "no" to any of the preceding questions, you are not eligible for employment with Woodhaven at this time.

* Are you a Vietnam Veteran?

Yes No

* Have you ever applied with Woodhaven?

Yes No

If yes, please list dates

* Do any of your friends or relatives, other than spouse, work here?

Yes No

* Have you ever been employed by Woodhaven?

Yes No

If yes, please list dates

* Have you ever been convicted of a crime, including misdemeanors, in the past seven years other than minor traffic offenses?

Yes No

If yes, please describe in full:

Please list other names you have been employed under:

Work Experience

Please list below current and past employment, beginning with your most recent employer

Employer Name

Address

Telephone Number

Job Title

Supervisor Name

Dates Employed

Salary

Reason for Leaving

May we contact?

Yes No

Other Employer

Employer Name

Address

Telephone Number

Job Title

Supervisor Name

Dates Employed

(start & end date)

Hourly Salary

Reason for Leaving

May we contact?

Yes No

Other Employer

Employer Name

Address

Telephone Number

Job Title

Supervisor Name

Dates Employed (start & end date)

Hourly Salary

Reason for Leaving

May we contact?

Yes No

Please list below employment history if those previously listed do not account for 10 years of employment.

Job History 1

Company Name

Address

Dates Employed (start & end date)

Job Title

Job History 2

Company Name

Address

Dates Employed (start & end date)

Job Title

Job History 3

Company Name

Address

Dates Employed (start & end date)

Job Title

Please include an explanation of gaps in employment.

Education

High School

School Name

Address

Course of Study

Years Completed

Diploma/Degree

College

School Name

Address

Course of Study

Years Completed

Diploma/Degree

Graduate

School Name

Address

Course of Study

Years Completed

Diploma/Degree

Technical

School Name

Address

Course of Study

Years Completed

Diploma/Degree

Are there any other experiences, skills, qualifications or certifications which will be of special benefit in the job for which you are applying? (Applicant should not list any information that Federal and/or State law precludes obtaining in the pre-employment process.)

Other Skills

Personal References (Do not include family members or past supervisors)

Reference 1

* Reference 1 Name

* Phone Number

* Occupation

* Relationship

Reference 2

* Reference 2 Name

* Phone Number

* Occupation

* Relationship

Reference 3

* Reference 3 Name

* Phone Number

* Occupation

* Relationship

Reasons for Employment at Woodhaven

* Please state your reasons for desiring employment at Woodhaven:

* Why do you feel you are a good candidate for employment?

* What do you find to be the most challenging part of working with individuals with disabilities?

To Applicant:

The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, creed, religion, sex or national origin.Federal law also prohibits other types of discrimination such as age, citizenship, disability, veteran status, attainment of benefits and participation in union activities. The laws of most states and many localities also prohibit some or all of the above types of discrimination as well as some additional types including, but not limited to, discrimination based upon ancestry, marital status, parental status, or source of income. The Fair Credit Reporting Act imposes restrictions with respect to credit data. The requested information is needed for legally permissible reason, including, without limitation, national security requirements affirmative action, a bona fide occupational qualification or business necessity.

Please Read and Initial

The facts set forth in my application for employment are true and complete. I understand that if employed, any false statement on this application may result in my dismissal. I further understand that this application is not and is not intended to be a contract of employment, nor does this application obligate the employer in any way if the employer decides to employ me. I understand and agree that my employment is "at will" and can be terminated by either party with or without notice at any time, for any reason or no reason. No one other than the Executive Director of the organization has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing and then only in writing signed by the Chief Executive Director.

* Initials

Employment "At Will"

The most widely used term on applications is the "employment at will" statement such as is found in the paragraph above. Missouri is described as an employment "at will" State. In order to be considered in any status other than employee "at will", an employee must allege a contract specifying a definite term. What this generally means is that a non-government employee may quit or be dismissed without cause at any time; in other words, there is an employment of indefinite duration, terminable at the will of either party.

* As a part of your application for a position with Woodhaven, we would like your permission to contact the employer(s) you have listed to obtain a reference of your previous employment. Your electronic signature below gives your previous employer(s) permission to speak with Woodhaven regarding your performance and their recommendation for your employment with us.

Applicant Electronic Signature

Please type the blue Verification Code in the box below.

* Verify

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