Cottonwood Ridge

Name

Email

Date of Application

Current address

Telephone

Date of Birth

Position Applied for

How did you learn of this opening?

Shifts Available

How many hours can you work weekly?

Employment desired

FULL-TIME only PART-TIME only FULL or PART-TIME

Have you ever worked for this company before?

Yes No

If yes to previous question, please state when, who the supervisor was and your reason for leaving.

Educational History

Do you have a QMAP certification?

Yes No

If so, when did you complete the class?

Have you ever been convicted of a felony?

Yes No

If yes, explain in detail. *A conviction record will not necessarily be a bar to employment, and factors such as age and time of the offense, the seriousness and nature of the violation, and the applicant's rehabilitation will be considered in the hiring decision. The applicant is responsible for providing final disposition paperwork.

Can you provide a copy of your disposition now?

Only following file types are accepted: jpg,png,jpeg,bmp,gif,doc,pdf,JPG,PNG,JPEG,BMP,GIF,DOC,PDF

Maximum upload size: 64.00 MB

Personal References and Former Employers

Military History

Work Experience

Personal References

May we contact your current employer?

Yes No

Did you complete this application yourself?

Yes No

If no, who filled out this application?

Employment Understanding

This institution does not discriminate on hiring or any other decision on the basis of race, color, sex, citizenship, natural origin, ancestry, Vietnam era veteran status, or on the basis of age or physical or mental disability unrelated to the ability to perform the work required. No question on this application is intended to be used for such discrimination.

I voluntarily give this institution the right to make a thorough investigation of my past employment and activities, agree to cooperate in such investigation and release from all liability or responsibility all person, companies or corporations supplying such information.

I understand my employment is at will, and that either party is free to terminate the employment relationship at any time without cause. I also understand that my employment may be terminated for any misstatement or omission of fact appearing on this application form.

I agree to submit to a pre-employment DRUG-SCREENING and that an offer of employment is conditional upon the results of that drug test.

I understand and agree to the above stated terms and conditions.

File Uploads

Do you have a resume and/or cover letter to send? (Word or Adobe PDF Only)

Yes No

Upload Resume

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Maximum upload size: 64.00 MB

Cover letter

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Maximum upload size: 64.00 MB

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Job Application

Personal References and Former Employers

Employment Understanding

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