Job Application Form

Please complete this accurately, giving as many details as possible about your skills and experience related to this position. Thank you.

Position


Personal Information






Background checks are required for all employees who may have unsupervised access to minors or adults with disabilities or acquired brain injury. Individuals who are listed on the DFS Central Registry or convicted of crimes against person or family are not eligible for employment with Mountain Regional Services, Inc. in this capacity.


I hereby authorize personnel of Mountain Regional Services, Inc., to conduct a reference check and background investigation into my work history, training, and education. The purpose of this inquiry is to seek job-related information which will be used to determine by qualifications and suitability for employment with Mountain Regional Services, Inc.

This will be kept in strict confidence and will be available only to agency personnel who are involved in the hiring decision. I further understand information disclosed will not be made available to me. A copy of this document is also acceptable to release information. This will release from any liability all individuals and organizations who provided information to Mountain Regional Services, Inc. in good faith and without malice concerning my competence, character, ethics, and other qualifications.




WORK HISTORY: List jobs in reverse order starting with your present or last job. Include any job-related military service assignments and volunteer activities. This section must be accurate and complete.




***NOTICE: SUCCESSFUL APPLICANTS WILL BE REQUIRED TO SHOW PROOF THAT THEY ARE ELIGIBLE TO WORK IN THE UNITED STATES UNDER U.S. LAW, AND PASS A PRE-EMPLOYMENT DRUG SCREEN, AND MEET OTHER PRE-EMPLOYMENT REQUIREMENTS.*** I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature. This means that the employee may resign at any time, and the employer may discharge the employee at anytime with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. I certify that all information contained on this application is true and complete to the best of my knowledge and belief. I understand that any misrepresentations or falsifications may result in removal from employment consideration or dismissal.