Southeast Missouri Community Treatment Center

SEMO CTC Employment Application

Employment Application

If you are interested in applying, please fill out the following and click Submit at the bottom of the page.

NOTICE TO ALL APPLICANTS

As part of our pre-employment procedures, you will be required to successfully complete a urine drug test. You will also be required to fill out certain pre-employment forms at the time of your interview. This application will remain active for no more than 90 days from the date it was made.

Southeast Missouri Community Treatment Center does not deny employment or services because of race, sex, color, creed, marital status, national origin, disability, or age of applicants or employees.

Personal Information

Your Email Address

First Name

Middle Initial/Name

Last Name

Maiden Name

Phone

Secondary Phone

Present Address

Present City

Present State

Present Zip Code

Permanent Address

Permanent City

Permanent State

Permanent Zip Code

Check if you are 18 years or older

In case of emergency notify

Name

Phone

Address

City

State

Zip

Relationship

Check if you are a US citizen or an alien authorized to work in the United States

Employment Desired

Position(s) Applying For (check all that apply)

Physician
Psychologist
Licensed Professional Counselor/Licensed Clinical Social Worker
Registered Nurse
Case Manager
Human Resources
Accounting/Business
Information Technology
Treatment Technician/Aide/Transporter
Clerical
Group Facilitator
Substance Abuse Counselor
Food Service Worker
Maintenance
Community Support Worker
Other (please list):

Availability

Full Time Part Time PRN Temporary

Date you can start

Salary/Pay desired

Have you ever applied to SEMO CTC before?

How long ago did you apply?

At what location did you apply?

Have you been employed by SEMO CTC?

Are you employed now?

If so, may we inquire of your employer?

Referred by

Do you know anyone at this company?(leave blank for none, list the name if yes)

Are you related to anyone at this company?(leave blank for none, list the name if yes)

Have you ever been convicted of a felony? Answering Yes will not automatically disqualify you from employment

If Yes, please explain

Education

	Name and Location of School	Number of years attended	Did you graduate?	Subjects Studied
Grammar School
High School
College
Trade, Business, or Correspondence School

The Age Discrimination in Employment Act of 1987 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age.

General

Subjects of special study or research work

Special Skills

Keyboarding Words per Minute:

10 Key Entry

Microsoft Access

Microsoft Word

Microsoft Excel

Any other software with which you are familiar

Any other skills you feel would be applicable

Professional licenses and number information

Professional certificates and expiration

Any other relevant training

Activities (civic, athletic, etc.)
Exclude organizations, the name of which indicates the race,
creed, sex, age, marital status, color, or nation of origin of its members

U.S. Military or Naval Service
Rank

Present membership in National Guard or Reserves

Former Employers

List below your last four employers, starting with the last one first

Date, Month and Year	Name, Address, and Phone Number of Employer	Salary	Position	Reason for Leaving
From To
From To
From To
From To

Which of these jobs did you like the best and why?

Personal References

Give the names and phone numbers of three persons not related to you, whom you have known at least one year.

Name	Phone Number	Address	Years Aquainted

By clicking submit I certify that the facts contained in my application for employment with Southeast Missouri Community Treatment Center, INC, are true and complete to the best of my knowledge and understand that if employed, falsified statements on the application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references listed on my application and/or any other documents given for pre-employment purposes to give you any and all information concerning my previous employment and any pertinent information they may have. By clicking submit below I hereby release forever all parties from all liability for any damage that may result from furnishing the same to you.

I understand and fully agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice and without cause.