Application For Employment

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.

Today's Date

Position(s) applying for:* Direct Support Professional (Residential)
Direct Support Professional (RISE Day Program)
Home Coordinator (Residential-experience required)
Realities Community Resource Coordinator (Some college/exp. req.)
Supervisor/Manager (Experience required)
Other

Other

Personal Information

First Name*

MI

Last Name*

Personal Pronoun (Other)

Primary Phone*

Secondary Phone

Email*

Address*

City*

State*

Zip*

Are you 18 years of age or older?* Yes No

Are you eligible to work in the United States?* Yes No

How did you hear about this position?* From Current Employee
Ad
Referral
Other

Explain Your Choice*

Preferred type of employment* Full-time (36+ hours per week)
Part-time (35 or less hours per week)
Either

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?* Yes No

Do you have a current valid driver's license?* Yes No

Do you have current active vehicle insurance?* Yes No

Do you have reliable transportation, in good/clean/safe condition; including working seatbelts, working air conditioner/heat, available for use on every shift you may work?* Yes No

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 38 in person classroom hours, at varying times. Do you agree to this?* Yes No

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

Are you related to any Willows Way clients or employees? Yes No

If yes, who?

Work History

Employer

City/State

Start Date

End Date

Job Title

Employment Type Full Time
Part Time

Responsibilities

Reason for Leaving

May we contact this employer for verification? Yes No

Employer

City/State

Start Date

End Date

Job Title

Employment Type Full Time
Part Time

Responsibilities

Reason for Leaving

May we contact this employer for verification? Yes No

Employer

City/State

Start Date

End Date

Job Title

Employment Type Full Time
Part Time

Responsibilities

Reason for Leaving

May we contact this employer for verification? Yes No

Volunteer, Internship, or Other Related Experience:
Describe any volunteer, internships, or other related experience you would like to share:

Education

Do you have a high school diploma or general equivalency diploma (GED)?* Yes No

List any education you have beyond high school below.

Name of School

City and State

# Credit Hours Completed

Area(s) of Study

Type of Degree (e.g., A.S., B.S., M.S.)

Degree Received Yes No

Name of School

City and State

# Credit Hours Completed

Area(s) of Study

Type of Degree (e.g., A.S., B.S., M.S.)

Degree Received Yes No

Name of School

City and State

# Credit Hours Completed

Area(s) of Study

Type of Degree (e.g., A.S., B.S., M.S.)

Degree Received Yes No

License/Certification

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

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

Name of Certification/License

Date of Issue

Expiration Date

Name of Certification/License

Date of Issue

Expiration Date

Name of Certification/License

Date of Issue

Expiration Date

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 out 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.

Upload Your Resume

I verify that this acts as my signature.*

Applicant Signature*

Date

Applicant Statements

Applicant Availability

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 Yes No

Are you available for awake overnight shifts? Yes No

Additional availability information:

Thank you for your interest in employment with Willows Way.

Be sure to check your email, we respond to everyone.

Have a great day!

Application For Employment

Subscribe to Willows Way