JOIN OUR TEAM

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Date of Birth

For background verification ONLY

MM

DD

YYYY

What is your current employment status?

Employed

Unemployed

Self-Employed

Student

CPR

Current

Expired

N/A

First Aid

Current

Expired

N/A

AED

Current

Expired

N/A

Level One Medication Aide

Current

Expired

N/A

Person-Centered Thinking

Current

Expired

N/A

Positive Behavior Supports

Current

Expired

N/A

Gentle Teaching

Current

Expired

N/A

Tools of Choice

Current

Expired

N/A

Available Start Day

MM

DD

YYYY

I'm available during pre-dawn hours these days

Between 12a-8a

Sun

Mon

Tues

Wed

Thur

Fri

Sat

Never

I'm available during day hours these days

Between 6a-4p

Sun

Mon

Tues

Wed

Thur

Fri

Sat

Never

I'm available during overnight hours with authorized sleep hours these days

Between 10p-9a

Sun

Mon

Tues

Wed

Thur

Fri

Sat

Never

I'm available for PRN/On-Call Rotation (24/7) these days

Sun

Mon

Tues

Wed

Thur

Fri

Sat

Never

I certify that the facts contained in this application are true to the best of my knowledge and understand that employment resulting from this application may be terminated if falsified statements are discovered by Harmony House Care Homes, Inc. I authorize investigation of all statements contained in the application and grant permission for employers listed within to disclose any information regarding my employment and character. My consent is hereby granted to Harmony House Care Homes, Inc. to conduct an inquiry regarding myself with the information contained within this application, solely for the purpose of establishing eligibility for employment with a Missouri Department of Mental Health, Division of Developmental Disabilities Contracted Provider.

If you agree to the terms set forth above, please select the checkbox.

I agree