Mission Road Ministries Application for Employment

Notice to applicants (please read carefully): Mission Road Ministries (MRM) is a private non-profit agency serving persons with developmental disabilities under licenses from State Regulatory authorities. Under these regulations, MRM is required to conduct criminal conviction checks before making an offer of employment. Therefore, any offer of employment resulting from this application is considered temporary, pending the results of a criminal conviction check.

Also, please note:
* You must answer every question completely. Questions not applicable may be answered N/A or none.
* Applications are not valid without the signature (typing your name will serve as a signature) of the applicant.
* Employment at MRM and any of its departments and locations shall be considered employment-at-will, in which either employer or employee may terminate the employment relationship for any reason or no reason

Do you have a valid driver's license?*

YesNo
If so, what state?*
Do you have a clear driving record? Note: MRM will conduct a Motor Vehicle Registration check for all applicants who will be a driver for MRM.*

YesNo
Please list your addresses in the past 7 years (including apartment number, city, state, and zip code)
Please list any volunteer experience (organization, dates/time frames, and contact persons name and phone number)
Mission Road has zero tolerance for abuse and will not tolerate the mistreatment or abuse of the individuals we serve in its programs.
Have you ever been accused of physically, sexually or emotionally abusing a child or an adult?*

YesNo
If yes, explain
References

Personal, Professional, and Family Member
(Personal Reference) Name*
(Personal Reference) Address*
(Personal Reference Phone) Number*
(Personal Reference) How long have you known this person?*
(Professional Reference) Name*
(Professional Reference) Address*
(Professional Reference) Phone Number*
(Professional Reference) How long have you known this person?*
(Family Member) Name*
(Family Member) Address*
(Family Member) Phone Number*
(Family Member) How long have you known this person?*
Signature*

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Date*

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Date

Educational Background