JOB APPLICATION

Strive Therapy & Wellness Center, LLC

16068 Boundary Dr Ste 1, Ashland, Mississippi 38603 662-224-2030

Strive Therapy & Wellness Center, LLC is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative.

Please fill out all of the sections below:
Applicant Name
Address

Address

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City, State and Zip CodeState / Province

Postal / Zip Code
Telephone Number
Format: (000) 000-0000.
Email Address
example@example.com
Date of Application

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Date
Employment Position Position(s) applying for: (full time)
Position(s) applying for: (full time)
How did you hear about this position?
What days are you available for work?
What hours or shift are you available for work?
On what date can you start working if you are hired?

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Do you have reliable transportation to and from work?
Salary desired
Personal Information Have you ever applied to or worked for Strive Therapy & Wellness Center, LLC before? Yes
If yes, when?
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Are you a U.S. citizen or approved to work in the United States? What document can you provide as proof of citizenship or legal status?
Yes
YESNO
YESNO
If yes, please describe accommodations required below.
YesNo
If yes, please state the nature of the crime(s), when and where convicted and disposition of the case
Job Skills/Qualifications
Please list below the skills and qualifications you possess for the position for which you are applying
(Note: Strive Therapy & Wellness Center, LLC complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible opplicants/employees to perform essential functions.
College/University
Name
Location (City, State)
Year Graduated
Degree Earned
Vocational School/Specialized Training
Name
Location (City, State)
Year Graduated
Degree Earned
Military:
Are you a member of the Armed Services?
What branch of the military did you enlist?
What was your military rank when discharged?
How many years did you serve in the Military?
What military skills do you possess that would be an asset for this position?
Previous Employment
Employer Name
Employer Telephone
Format: (000) 000-0000.
Supervisor Name
Job Title
City, State and Zip Code
Employer Address
Reason for leaving
Dates Employed

MonthDayYear
Date
Employer Name
Employer Telephone
Format: (000) 000-0000.
Address

Employer Address

Street Address Line 2

City, State and Zip CodeState / Province

Postal / Zip Code
Supervisor Name
Job Title
Reason for leaving
Dates Employed

MonthDayYear
Date

References Please provide 2 personal and professional reference(s) below:

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The relationship between you and the Strive Therapy & Wellness Center, LLC is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Strive Therapy & Wellness Center, LLC. No representative of Strive Therapy & Wellness Center, LLC has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's President.
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