KCMH Employment Application

1
Our policy is to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental disability, or veteran status.
2
About You* This field is required.
Full Name
Address
Phone Number
Email Address
3
Additional Information* This field is required.
Personal Referral
Online Job Board
Social Media
How did you hear about this opening?
When can you start?
What's your desired wage?
4
Additional Information Cont.
Yes
No
Are you a legal U.S. citizen or otherwise authorized to work in the U.S on an unrestricted basis?
Yes
No
Are you looking for full-time employment?
If no, what hours are you available?
Yes
No
Have you ever been convicted of a Felony?
If yes, please describe conditions.
5
Education
6
High School
Name
Address
Years Attended
Degree | Certification
7
College
Name
Address
Years Attended
Degree | Certification
8
Post-College
Name
Address
Years Attended
Degree | Certification
9
Other Training
Name
Address
Years Attended
Degree | Certification
10
Employment
11
Employer #1
Name
Address
Telephone
Date Started
Starting Position
Date Ended
Ending Position
12
Additional Information
Name of Supervisor
Yes
No
May we contact?
Responsibilities
Reason for leaving
13
Employer #2
Name
Address
Telephone
Date Started
Starting Position
Date Ended
Ending Position
14
Additional Information
Name of Supervisor
Yes
No
May we contact?
Responsibilities
Reason for leaving
15
Employer #3
Name
Address
Telephone
Date Started
Starting Position
Date Ended
Ending Position
16
Additional Information
Name of Supervisor
Yes
No
May we contact?
Responsibilities
Reason for leaving
17
In addition to your work history, are there other skills, qualifications, or experience that we should consider?
18
Attach additional information if necessary (Resume, CV, References, etc.)
19
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Select files to upload
Max. file size: 10.6MB
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20
I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. This company is hereby authorized to make any investigations of my prior educational and employment history.
21
I understand that employment at this company is at will, which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of this company, other than the president, has any authority to alter the foregoing.
22
Signature* This field is required.
23
Date* This field is required.
Month
Day
Year
Should be Empty:

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