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If at any time during the application or selection process, you believe you may require a special accommodation to perform the work for which you are applying, or assistance completing this application, please inform the Human Resources Department.

Please note that we conduct Pre-Employment Drug Screenings and use E-verify to verify eligibility for employment.

Name: *

First

Middle

Last

Date of application: *

Today's Date

Preferred name:

Personal pronouns: *

She/Her
He/Him
They/Them
Other (Please Specify)
Do not wish to share

Position Applying for: *

Cell phone: *

Email address: *

Confirm Email

Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Are you 18 years of age or older? *

Are you eligible to work in the United States? *

How did you hear about this position? *

Current or Past Employee
Job Website
Social Media
Community Event
Other (Please Identify)

Name of Employee: *

Which Job Website? *

Indeed
ZipRecruiter
Willows Way Career page
Social Media
Other (Please specify)

Which Social Media Platform? *

Facebook
Instagram
LinkedIn

Please Identify Where? *

Please Tell Us What Event? *

Please Specify Where? *

What type of employment are you seeking? *

Full-time (36+ hours)
Part-time (Less than 36 hours)
PRN (As needed)

Number of hours desired per week: *

Check all geographic work locations where you are willing to travel: *

Anywhere in North St. Louis County
Anywhere in South St. Louis County
Anywhere in West St. Louis County
Anywhere in St. Charles County

Have you ever been employed by Willows Way, Inc.? *

If yes, when? *

Do you have a current valid driver’s license? *

Do you have current active vehicle insurance? *

For Direct Support Roles: Do you have reliable transportation, including a vehicle with working seatbelts, heat / air conditioning, and in a clean and safe condition, available to you for every shift you may work? *

For Direct Support Roles: Depending on your experience and prior training, you will be required to attend 50+ hours of online training within the first 3-5 weeks of employment and 40 in-person classroom hours at varying times. Do you agree to this? *

If hired, when would you be available to begin working for Willows Way? *

Are you related to any Willows Way clients or employees? *

If yes, who? *

(Begin with most recent employer)
Please list your previous employers, the dates you worked and the position you held.

Employer: *

From: *

Employer's City, State: *

To: *

Currently: *

I am currently employed here
I'm not employed here

Job Title: *

Employment Type: *

Full-time
Part-time

Responsibilities: *

Reason for leaving: *

May Willows Way, Inc. contact this employer for verification of information provided on this form? *

If no, please explain? *

Work History 2

Employer: *

From: *

Employer's City, State: *

To: *

Currently: *

I am currently employed here
I'm not employed here

Job Title: *

Employment Type: *

Full-time
Part-time

Responsibilities: *

Reason for leaving: *

May Willows Way, Inc. contact this employer for verification of information provided on this form?

Explanation, if applicable:

Work History 3

Employer: *

From: *

City, State: *

To: *

Currently: *

I am currently employed here
I'm not employed here

Job Title: *

Employment Type: *

Full-time
Part-time

Responsibilities: *

Reason for Leaving: *

May Willows Way, Inc. contact this employer for verification of information provided on this form? *

If no, please explain? *

Volunteer, Internship, or Other Related Experience:

Describe any volunteer, internships or other related experience you would like to share:

Education/Skills

Do you have a high school diploma or high school equivalency diploma? *

Education Beyond High School

Please list your previous education.

Name of school:

City and state:

# of credit hours received:

Areas(s) of study:

Type of degree

(e.g., A.S., B.S., M.S.)

Degree received?

Note: Copies of diplomas and/or educational transcripts or equivalent are required upon employment.

Education Beyond High School 2

Name of school

City and state

# of credit hours received

Areas(s) of study

Type of degree

(e.g., A.S., B.S., M.S.)

Degree received?

Note: Copies of diplomas and/or educational transcripts or equivalent are required upon employment.

License/Certification

(e.g., Mandt, CPR, First Aid, CNA, LPN, RN, etc.)

Name of Certification/License:

Date of Issue

Expiration Date

Note: Copies of licenses/certificates or equivalent may be required upon employment.

Applicant Availability for Direct Support Roles Only

Please Note: Willows Way, Inc. provides continuous 24-hour support to people with disabilities. Applicants seeking to work directly with individuals with disabilities in our residential program may limit their opportunity for employment if they have limited availability, especially if seeking full-time employment.

Are you applying for DSP position? *

Yes
Not applicable

Please tell us what hours you are available for work each day of the week.

Sunday:

Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

Saturday:

Are you available for *asleep overnight shifts? *

*Asleep overnights paid at minimum wage

Are you available for awake overnight shifts? *

Additional availability information:

Background Checks

If you are listed as ‘disqualified for employment’ on any funder lists i.e. Division of Health & Senior Services, Department of Mental Health, or have been convicted of a ‘disqualifying crime’ per our funder guidelines, you may be ineligible for hire.

Disclaimer: Do you agree? *

I agree to the above statement.

To the best of my knowledge, the answers on this application are true and correct. I realize that falsification of any of the application information may be cause for (1) not being employed, or (2) termination, if hired. Failure to answer all of the requested information on this application may result in my not being considered for employment. Furthermore, I understand that Willows Way is an At Will Equal Opportunity Employer. I understand that I will be required to pass any required background checks if offered a position with Willows Way.

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