PLEASE FILL IN ALL INFORMATION

Application for
Employment

APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS

Personal Information

DATE

Name

                     Last                                                     First                                                             Middle                                              

Present address 

                                                       Number                             Street                                      City                  State                Zip

How long  at this address:

Telephone                                                                                  Email Address

Position applied for      

and salary desired       

(Be specific)

Days/hours available to work

No Pref  Thur

Mon         Fri   

Tue          

Wed         

How many hours can you work weekly?   Can you work nights?   Yes / No

Employment desired         FULL-TIME ONLY             PART-TIME ONLY             FULL- OR PART-TIME

When are you available for work?   

TYPE OF SCHOOL

NAME OF SCHOOL

LOCATION
(Complete mailing address)

 NUMBER OF YEARS COMPLETED

MAJOR & DEGREE

High School

College

Bus. or Trade School

Professional School

HAVE YOU EVER BEEN CONVICTED OF A CRIME?   No                    Yes

If yes, explain number of  conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.

Please list two references other than relatives or previous employers.

Name        

Name    

Position    

Position

Company 

Company

Address    

Address

Telephone 

Telephone 

Background

An application form sometimes makes it difficult for an individual to adequately summarize a complete background.  Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

Work Experience

Please list your work experience for your two most recent employers

Name of employer (Last)
Address

Name of last supervisor

Employment dates

Salary
 

City, State, Zip Code
Phone number

From

To    

Start

Final

Your last job title

Reason for leaving (be specific) 

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Name of employer (Previous)

Name of last previous

Employment dates

Salary

Address: City, State, Zip Code
Phone number

From

To    

Start

Final

Your last job title

Reason for leaving (be specific) 

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

PLEASE READ CAREFULLY

APPLICATION FORM WAIVER

In exchange for the consideration of my job application by St. Louis College of Health Careers (hereinafter called “the Company”), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of  St. Louis College of Health Careers, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /General Manager of the Company.  Both the undersigned and  St. Louis College of Health Careers may end the employment relationship at any time, without specified notice or reason.  If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application.  I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice.  I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract.

I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy.  I further understand that continued employment may be based on the successful passing of job-related physical examinations.

I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living.  Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

I further understand that my employment with the Company shall be probationary for a period of sixty (60) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.

I have read the above application waver and agree   Yes           No

This Company is an equal employment opportunity employer.  We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability.  We assure you that your opportunity for employment with this Company depends solely on your qualifications.

Thank you for completing this application and for your interest in  St. Louis College of Health Careers