APPLICATION FOR EMPLOYMENT |
Carpenter Place, 1501 N Meridian, Wichita, KS 67203 |
| Print and complete this entire form and mail or deliver to Directory of Services, MCCH, 1501 N Meridian, Wichita, KS 67203. |
Prospective employees will receive consideration without illegal discrimination because of race, color, sex, age, ancestry, national origin, disability, or veteran status. |
| PERSONAL |
Last Name
|
First Name
|
Middle
|
Date
|
| Street Address |
Home Telephone
(____) ____-______ |
| City |
State |
Zip |
Position Desired
|
Have you ever been convicted of a crime?
 Yes* No If "Yes, describe in detail.
|
*A conviction record will not necessarily be a bar to employment, and factors such as age and time of the offense, the seriousness and nature of the violation, and the applicant's rehabilitation will be considered in the hiring decision. However, failture to pass a Kansas Bureau of Investigation background check will prevent employment.
|
Special training or skills (eg., languages, machine operations, etc.)
|
| EMPLOYMENT |
| Please give accurate, complete full-time and part-time employment record. Start with your present or most recent employer. |
| Company Name |
Telephone
(_____ )______ - ______________
|
| Address |
Employment Dates (month/yr)
From ______________ To_________________
|
| Name of Supervisor |
Weekly Pay
Start_______________ Last ________________
|
| State Job Title and Describe Your Work |
Reason for Leaving |
| Company Name |
Telephone
(_____ )______ - ______________
|
| Address |
Employment Dates (month/yr)
From ______________ To_________________
|
| Name of Supervisor |
Weekly Pay
Start_______________ Last ________________
|
| State Job Title and Describe Your Work |
Reason for Leaving |
| Company Name |
Telephone
(_____ )______ - ______________
|
| Address |
Employment Dates (month/yr)
From ______________ To_________________
|
| Name of Supervisor |
Weekly Pay
Start_______________ Last ________________
|
| State Job Title and Describe Your Work |
Reason for Leaving |
| Company Name |
Telephone
(_____ )______ - ______________
|
| Address |
Employment Dates (month/yr)
From ______________ To_________________
|
| Name of Supervisor |
Weekly Pay
Start_______________ Last ________________
|
| State Job Title and Describe Your Work |
Reason for Leaving |
| READ CAREFULLY BEFORE SIGNING |
| In signing and submitting the application for employment to Maude Carpenter Children's Home, I clearly understand and agree: (1) I certify that the information contained in this application is correct and complete to the bst of my knowledge and understand that any omission, misrepresentation, or falsification of information made herein or in any interviews is grounds for refusal to employ me or my dismissal, if I am employed; (2) I authorize the references l isted above, schools and current and past employers to give MCCH any and all information concerning my previous employment and any information they may have, personal or otherwise, and I release all parties from all liability for any damage or claim that may result from furnishing the same to MCCH; (3) If I am employed, I agree to abide by the rules, regulations and policies of MCCH, and understand that my employment is at-will and that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either MCCH or myself; (4) I understand that no representative of MCCH, orther than the President or designee, has any authority to enter into any agreement for employment for any specified period of time, or make any agreement contrary to the foregoing; (5) I understand that my continued employment depends upon my satisfacotirly passing a Motor Vehicle Report and Kansas Burea of Investigation check; (6) I understnad that MCCH is a drug-free workplace and that I may be subject to drug testing to ensure the safety and well-being of the children. |