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Careers

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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

Preferred name

Personal pronouns

She/Her
He/Him
They/Them
Other (Please Specify)

Please specify

Position Applying for:

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Cell phone

Email address

Address

Address Line 1

Address Line 2

City

State

Zip Code

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Are you 18 years of age or older?

Are you eligible to work in the United States?

How did you hear about this position?

From Current Employee
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Referred by Current Employee

Name of employee

Indeed
ZipRecruiter
Other (Please specify)

Other

Name of employee

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 working seatbelts, working air conditioner/heat, vehicle in overall good/clean/safe condition and available to you for every shift you may work?

For direct support roles: depending on your experience & 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?

Work History (Begin with most recent employer)

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Employer

From:

City, State

To:

I am currently employed here

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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 2

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Employer

From:

City, State

To:

I am currently employed here

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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

Layout 3

Employer

From:

City, State

To:

I am currently employed here

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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:

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

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Name of school

City and state

# of credit hours received

Areas(s) of study

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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.

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Name of school

City and state

# of credit hours received

Areas(s) of study

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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.)

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Name of Certification/License

Date of Issue

Expiration Date

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

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.

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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Signature

Clear Signature

Date

Applicant Availability for Direct Support Roles Only

Not applicable

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.

During what time frames are you available to work :

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: