• Job Application

    Please complete the form below to apply for a position with us.

  • Social Security Number :*

  • Job Interest

  •  - -

  • SELECT ALL DAYS YOU ARE AVAILABLE TO WORK
                      *      

  • Until
  • Until

  • EMPLOYEE MEETS ONE OF THE FOLLOWING EXPERIENCE QUALIFICATIONS

    Select all that apply

  • Has at least 6 months paid experience as:
             

  • Has at least 1 year's experience (paid or unpaid) as:
             

  • Has successfully completed training as:
             

  • Do you have any criminal convictions, findings of guilt, pleas of guilt, or pleas of nolo contedere except minor traffic offensenes?      *   If yes, explain.

  • Have you ever been listed on the Missouri Division of Health and Senior Services Employee Disqualification List?      *      If yes, please explain.

  • Have you ever used any alias names or a different social security number?      *      
    If yes, please list and describe:

  • Have you ever been suspended or terminated due to abuse, neglect, or exploitation of a resident or patient?      *   If yes, explain?

  • Is there any reason that you would be ineligible to work as an Attendant?
       *     
    If yes, please explain.

  • I give Criterion In-Home Health Service LLC permission to submit a criminal record check.       

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  • I give Criterion In-Home Health Service LLC permission to submit a closed records check at Criterion In-Home Health Service LLC discretion?

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  • Acknowledgement (Please Read Carefully)

    I hereby certifiy that the information contained in this application form and in any attachments listed below (hereafter made apart of this application) is true and correct to the best of my knowledge and agree to have any of the statements checked by the organization unless i have indicated to the contrary. I authorize the references listed above to provide the company any and all information concerning my previous employment and any pertinent infromation that they may have. Further, I release all parties and persons from any and all liablility for any damages that may result from furnishing such infromation to the company as well as from the use or disclosure of such information by the organization or any of its agents, employees or representatives. I understand that any misrepresentation, falsification, or material commission of information on this application may result in my failure to receive an offer or, if I am hired, in my dismissal from employment.

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  • Application Instructions

  • After you click the "Submit" button you will be taken to an orientation page.


    Please follow every step in order to accomplish the best results during the paid training session.


    After completing your Training as part of your application we will let you know if you qualify so please try to follow the instructions to the letter.



    Click the button below to submit this application:

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