EMPLOYMENT APPLICATION FORM

Please CLICK HERE to send your Resume and References to the Human Resource Manager before completing this application.

CLICK HERE to download a PDF version of our application.

Please submit to 1900 Prathersville Road, Columbia, MO

First Name:

Middle Name:

Last Name:

Complete Address:

Years At Current Address:

Email:

Phone:

Are you 21 years of age: Yes No

List Any Military Experience (Current or Past):

Social Security #:

Current Driver's License Class:

Postion Applying For:

Willing To Take A Drug Test? Yes No

 

Are you able to perform essential functions of the position for which you are applying without special accommodations? Yes No

If NO, Explain:

 

Education History

Choose Highest Degree Completed: GED H.S. Diploma Some College AA/AS BA/BS Grad. Degree PHD/MD

Year Graduated:

Name & Location of High School?

Describe Any Technical Schooling:

 

Employment History

(Last Five Years): *If you have had more than three jobs in five years you are to bring additional employment history on another sheet of paper and attach to application.*

Employer:

Address:

Phone:

Date Started:

Date Ended:

May We Contact? Yes No

Supervisor:

Job Title:

Final Salary:

Job Description:

Reason For Leaving:

 

Employer:

Address:

Phone:

Date Started:

Date Ended:

May We Contact? Yes No

Supervisor:

Job Title:

Final Salary:

Job Description:

Reason For Leaving:

 

Employer:

Address:

Phone:

Date Started:

Date Ended:

May We Contact? Yes No

Supervisor:

Job Title:

Final Salary:

Job Description:

Reason For Leaving:

 

Describe skills, training, or experience related to the position that you are applying for:

Provide any volunteer/internship experience:

If you have had gaps of unemployment, explain those gaps:

If applying for a part time position, please list hours of availability:

Please describe what you believe Reality House Programs to be and the way you see the position you are applying for to fit into the organization:

How do you anticipate your demeanor will be with people who have been convicted of criminal behavior?

If hired, what type of relationship do you anticipate having with current or past participants of Reality House Programs?

If you have working experience in the following, please check each skill:

Microsoft Word     Microsoft Access    Microsoft Publisher   Microsoft PowerPoint  

Microsoft Outlook   Ten Key   Excel   Typing/WPM  

I authorize the Release of Information concerning ALL of my current and previous employment to Reality House Programs, Inc. I understand that the information will include my period of employment, official title(s), duties and responsibilities, work habits, attitude, and reason for termination. I understand that Reality House Programs, Inc. staff will contact my references, investigate my employment & education history, and verify that the information that I provided in this application is accurate. By making such authorization, I release my previous employer, Reality House Programs, Inc., and the listed references from all liability and damage resulting from said release.

Reference 1

Current Job

Phone

Reference 2

Current Job

Phone

Reference 3

Current Job

Phone

• I understand that this application is not a contract of employment;
• I understand that federal law prohibits employment of illegal aliens;
• I understand that I must show proof of identity and that failure to do so will result in denial of employment;
• I understand that Reality House Programs, Inc. follows an employment-at-will policy and may terminate my employment at anytime and for any reason.

I certify that all statements herein are true and I also understand that any falsification or willful omission will be sufficient cause for dismissal or refusal of employment. If I am employed, I will follow all directives and policies of Reality House Programs, Inc. and my supervisors.

I understand by typing my name in this blank I am electronically signing this application.

Type verification image: