CARE Partners, LLC
915 Southwest Blvd, Suite K-2
Jefferson City, MO 65109
Phone:573.893.2273
Fax: 573.893.2274

Job Application

Personal Information

   
Last Name:
First Name:
Middle Name/Initial:
 Prior Aliases Used i.e. Maiden Name:  
Social Security Number::
Social Security Number::
 Prior Social Security Number:  
Email Address::
Street Address::
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Home Phone::
Mobile Phone::
Are you a citizen of the United States and/or authorized to work in the United States?
  Are you 18 or older?
If yes, Date of Birth:
Military Service?
Have you ever had any criminal convictions, findings of guilt, pleas of guilty, and pleas of nolo contendere, except minor violations?:
If yes, please explain:
 Are you a veteran?
What position are you applying for?
How did you hear about this position?
Are you listed on the DHSS EDL?
 If yes, date you were placed?  
Expected hourly rate:
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 Part Time:
Date Available:
 Weekdays?
 Weekends?
 Evenings?
 Nights?
If part time, please specify days/hours available:
If this job requires, do you have the appropriate valid driver's license?
Automobile Insurance?

Employment History

Current or Most Recent Employer:
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Dates of Employment:
Hourly Rate/Salary:
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 May we Contact:
Prior Employer Name:
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Position/Job Title:
Name of Immediate Supervisor/Position:
Dates of Employment:
Hourly Rate/Salary:
Reason for Leaving:
  May we Contact
Prior Employer:
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Position/Job Title:
Name of Immediate Supervisor/Position:
Dates of Employment:
Hourly Rate/Salary:
Reason for Leaving:
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Education


High School Name:
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  Diploma?
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References

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Disclaimer:  By signing, I hereby certify that the above information, to the best of my knowledge, is true and correct.  I understand that falsification of this information may prevent me from being hired or lead to my dismissal if hired.  I also provide consent for former employers to be contacted regarding work records.  I also agree to a criminal background check and a closed record check being completed prior to hire.
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