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Name:
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Address:
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E-mail Address:
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Year
Position
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How were you referred to us?
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LinkedIn
Facebook
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Other
Were you referred by a Life Unlimited or MERIL employee?
Yes
No
If so, who?
Can you perform the essential functions of the position for which you are applying?
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Yes
No
If no, please specify:
Date of Availability
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Month
-
Day
Year
Date
Employment desired?
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Full-time
Part-time
PRN
Availability
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Are there any days/times you are NOT available?
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Which shifts are you willing to work?
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Daytime
Evening
Weekend
Work location preference (St. Joseph, Buchanan County, Andrew County, Dekalb County, Maryville, Nodaway County):
Upload Resume:
Have you been terminated from employment or asked to resign by an employer?
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Yes
No
If yes, please provide detailed information:
If currently employed, may we inquire of your current employer?
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Yes
No
If yes, please provide current employer contact information (employer name, supervisor name, and phone number)
What is the highest level of education you have completed?
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High School
Trade or Vocation School
Some College Work
Associate's Degree
Bachelor's Degree
Some Graduate Work
Graduate Degree
List any degrees or certificates you have obtained (include name of school and date obtained):
Life Unlimited - MERIL requires all applicants to be registered with the Missouri Family Care Safety Registry and undergo E-Verify certification. Check the box above to indicate that you have read this notice.
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Yes, I have read this notice.
List any special skills, talents, experiences or trainings that would enhance your ability to perform the position applied for:
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Describe your computer skills:
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Reference 1
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List the name of a person not related to you whom you have known at least three years. Please provide name, address, phone number, email address, and a description of your relationship to the person.
Reference 2
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List the name of a person not related to you whom you have known at least three years. Please provide name, address, phone number, email address, and a description of your relationship to the person.
Reference 3
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List the name of a person not related to you whom you have known at least three years. Please provide name, address, phone number, email address, and a description of your relationship to the person.
Please read carefully before agreeing. It is the policy of Life Unlimited, Inc. not to discriminate on the basis of race, color, religion, national origin, sex (including pregnancy and wages related to gender), sexual orientation, disability, age, genetics, or veterans. I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Life Unlimited, Inc. to hire me. If I am hired, I understand that either Life Unlimited, Inc. or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Life Unlimited, Inc. has the authority to make any assurance to the contrary. I attest with my signature below that I have given Life Unlimited, Inc. true and complete information on this application. No requested information has been concealed. I authorize Life Unlimited, Inc. to contact references provided for employment reference checks, to complete background checks and conduct drug testing. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for denial of employment or immediate dismissal.
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Yes, I have read this notice.
Signature
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