EMPLOYMENT APPLICATION

The Bluffs is an Equal Opportunity Employer, and gives all applicants for employment equal consideration regardless of race, color, sex, sexual orientation, religion, national origin, age, physical or mental disability genetic information, marital status, citizenship status, veteran status, pregnancy, or any other status protected by Federal, State or Local Law. Upon request and consistent with applicable laws, The Bluffs will provide reasonable accommodations to individuals with disabilities who need an accommodation to fully participate in the application process. If you have any issues submitting the online application or have additional questions please contact us at Email us: HR@thebluffscolumbia.org

General Information

Please complete all requested information.

Please Enter Your Availability For Each Day

Monday Type a label
Tuesday Type a label
Wednesday Type a label
Thursday Type a label
Friday Type a label
Saturday Type a label
Sunday Type a label

EDUCATION & TRAINING

Please include name, street, city, state and zip code for each school

WORK EXPERIENCE

Please provide your previous experience, beginning with your most recent position

Employer 1

Employer Name
Job Title
Starting Salary Ending Salary
Street Address Street Address Address Line 2 City State Zip
Worked From (Month/Year) to (Month/Year) Telephone Area Code Phone Number
Supervisors Name First Name Last Name
Can we contact this employer? Yes No
Reason for leaving? Type a label
What were your responsibilities: Type a label

Employer 2

Employer Name
Job Title
Starting Salary Ending Salary
Street Address Street Address Address Line 2 City State Zip
Worked From (Month/Year) to (Month/Year) Telephone Area Code Phone Number
Supervisors Name First Name Last Name
Can we contact this employer? Yes No
Reason for leaving? Type a label
What were your responsibilities: Type a label

Employer 3

Employer Name
Job Title
Starting Salary Ending Salary
Street Address Street Address Address Line 2 City State Zip
Worked From (Month/Year) to (Month/Year) Telephone Area Code Phone Number
Supervisors Name First Name Last Name
Can we contact this employer? Yes No
Reason for leaving? Type a label
What were your responsibilities: Type a label

Additional Employment History Inquires

According to Missouri Law 660.317, any applicant that knowingly fails to disclose his/her criminal history as required in subsection 5 of this section is guilty ofa Class A Misdemeanor. A provider is guilty of a Class A Misdemeanor if the provider knowingly hires or retains a person to have contact with patients or residents and the person has been convicted of, pied guilty to or nolo contendere in this state or any other state or has been found guilty of a crime, which is committed in MO would be a Class A or B felony violation, NOT DISCLOSING CRIMINAL HISTORY IS GROUNDS FOR TERMINATION OF EMPLOYMENT AS THIS IS FALSIFICATION OF APPLICATION. A conviction will not necessarily disqualify an applicant from employment. The Bluffs looks at several factors in determining eligibility.

REFERENCES

Please provide three (3) professional references

Name First Name Last Name
Job Title
Telephone Area Code Phone Number
Email Email
Street Address Street Address Address Line 2 City State Zip

Name First Name Last Name
Job Title
Telephone Area Code Phone Number
Email Email
Street Address Street Address Address Line 2 City State Zip

Name First Name Last Name
Job Title
Telephone Area Code Phone Number
Email Email
Street Address Street Address Address Line 2 City State Zip

Referral Source

Additional Questions

Pre-Employment Checks and Fees (Please Read)

The Bluffs runs the following pre-employment checks on all candidates for employment with the following fees deducted from the employee's first paycheck. Criminal Background Check $15.55 Family Care Safety Registry $14.53 Missouri Division of Aging-Employee Disqualification List $0.00 Office of the Inspector General $0.00 CNA Registry $0.00 Nursys Licensing Registry $0.00

Initial here Type a label* if you agree to have the following pre-employment record checks and fees deducted from your first paycheck.

APPLICANT STATEMENT

I have read and fully understand the questions asked in this application. I certify that all of the answers I have given are true, accurate and complete. I understand that the omission and/or misrepresentation of any fact from or on this application or during my interview will result in immediate rejection of my application or if I am hired will be cause for immediate dismissal. Unless I noted otherwise, I authorize The Bluffs to contact all of my employment references as well as the education institutions I have attended. I further authorize The Bluffs to inquire about, investigate and obtain copies of any records which relate to me from my former employers and/or education institutions. I hereby release The Bluffs, as well as any person or institution that provides The Bluffs with any unlawful information about me, from any and all liability whatsoever resulting from such lawful inquiry, investigation or communication, If hired, I agree to abide by all of the rules and regulations of The Bluffs. I understand and agree that nothing in this application shall constitute an offer, a contract or a guarantee of employment for a specific period of time. If hired, I understand that my employment is at-will and may be terminated with or without cause and with or without notice at any time, at the option of either The Bluffs or myself. I understand that any hiring decision is contingent upon my successful completion of all of The Bluffs lawful pre-employment checks. I agree to execute any consent forms necessary for The Bluffs to conduct is lawful pre-employment checks.