Application for Employment

Application for Employment
Saint Louis Crisis Nursery, Regional Administrative Offices 11710 Administration Dr., Suite 18, Saint Louis, MO 63146

Phone: 314.292.5770 Fax: 314.292.5776

Email completed application and resume to: employment@crisisnurserykids.org
THE SAINT LOUIS CRISIS NURSERY is an equal opportunity employer. We consider applicants for all positions without regard to actual or perceived race, color, religion, creed, sex, gender, sexual orientation, gender identity, national origin, ancestry, citizenship, age, disability, pregnancy, genetic information, marital status, military or veteran status, or any other legally protected status. We provide reasonable accommodations for qualified individuals with known disabilities, unless doing so would result in an undue hardship as defined by law. Please let us know if you need an accommodation to complete the application process.
Date of Application*

MonthDayYear
Date
How did you hear about this position?*
Name*

First NameMiddle InitialLast Name
Previous Name(s)
Current Address*

Street Address

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number with area ode.
Is the Number Listed Above a Cell Phone?*

YesNo
Is it Okay to Text?*

YesNo
Email Address*
example@example.com
Position Applying For
Desired Starting Pay*
Date Available to Start Work/Notice Period *
Availability (Choose all that Apply)*

DaysEveningsWeekend Shiftsovernights
Desired Status*

Full TimePart Time
Locations convenient for you (Choose all that Apply)*

South St Louis CitySt Louis North CountySt CharlesWentzville
Please rate each of the following regarding their importance to you

(5=Very Important; 4=Important; 3=Moderately Important; 2=Of little importance; 1= Unimportant)
Flexibility      *
Energy Level    *
Teamwork    *
Communication         *
Strengths Based Perspective     *
Are you at least 21 years old? (A Division of Children's Services Requirement)*

YesNo
Are you legally eligible for employment in the United States of America? (*If "yes" verification will be required upon employment)*

YesNo
Note: post offer we require fingerprints that are run nationwide through the FBI and must exclude certain offenses
EDUCATION

Name of High School   *
High school or equivalent (GED)?   Yes   No*
Name of University
Degree In Progress Associates   Bachelors  Masters   N/A
Degree Completed (if applicable)   Associates   Bachelors   Masters   N/A
Major Field of Study
Current Certificates/ Licenses
EMPLOYMENT - List Present Job First

Employer   *
Phone Number  *
Job Title  *
Dates Employed from Date*   to    Date
Reason for Leaving *
May We Contact Employer Yes   No*

Employer
Phone Number
Job Title
Dates Employed from Date   to  Date
Reason for Leaving
May We Contact Employer Yes   No

Employer
Phone Number
Job Title
Dates Employed from Date    to   Date
Reason for Leaving
May We Contact EmployerYes   No
Are you a party to any agreement (e.g. any non-compete, non-solicitation, or confidentiality agreement) that would or may prohibit or restrict you from being employed by, or performing services for, the Saint Louis Crisis Nursery?*

YesNo
APPLICANT’S STATEMENT: PLEASE READ THIS STATEMENT BELOW CAREFULLY. YOUR APPLICATION WILL BE CONSIDERED INCOMPLETE IF NOT SIGNED AND DATED

I certify that the statements and information provided by me on this application for employment are true, accurate and complete to the best of
my knowledge.

I authorize The Saint Louis Crisis Nursery to investigate all statements contained in this application unless specifically stated otherwise inthis application for employment. I authorize the Saint Louis Crisis Nursery to contact the employers identified above for purpose ofverifying the accuracy of the information contained in this application, and discussing my work performance, conduct and qualifications.

I understand that any misrepresentations, false statement, false information, or material omissions made by me on this application for employment (or on any other accompanying or required documents) and/ or during any interview may result in the exclusion of my application from further consideration or, if I am hired, termination of my employment regardless of when or how discovered.

I understand that neither this application for employment nor any other document or statement of the Saint Louis Crisis Nursery constitutes a contract or agreement of employment. I understand that if I am hired, my employment will be “at-will” and, as such, may be terminated by either party at any time, with or without cause. If hired, I agree to comply with all polices and procedures of the Saint Louis Crisis Nursery, including, without limitation, those concerning conflicts of interests, standards of business ethics, conduct health, equal employment opportunity, safety and security.

I understand that the Saint Louis Crisis Nursery prohibits the disclosure of its confidential and proprietary information, and I agree to comply with that prohibition, whether or not I become an employee. To the extent that confidential or proprietary information is disclosed to or otherwise acquired by me, whether during the application process or if I am hire, after I become an employee I shall not disclose such information to any third-party (except as required int eh ordinary course of employment by the Saint Louis Crisis Nursery and for the sole benefits of the Saint Louis Crisis Nursery and except for disclosures to government agencies).

I represent to the Saint Louis Crisis Nursery that I am not a party to any agreement that would prohibit or restrict me from being employed by, or performing services for the Saint Louis Crisis Nursery
Name*
Date*

MonthDayYear
Date
Signature*

Clear
By checking this box, I certify that I have signed this application
Should be Empty:

Application for Employment

Please rate each of the following regarding their importance to you

Note: post offer we require fingerprints that are run nationwide through the FBI and must exclude certain offenses

EDUCATION

EMPLOYMENT - List Present Job First