MERIL Employment Application – MERIL – Helping People with Disabilities Live Independently!

Today's Date (mm/dd/yyyy) *

Name *

First

Middle

Last

Street Address *

City *

State *

ZIP Code *

Phone Number(s) *

Email *

Position Desired *

Can you perform the essential functions of the position for which you are applying? *

Yes
No

If you are not able to perform the essential functions of the position, please explain:

Date of Availability (mm/dd/yyyy) *

Are you at least 18 years of age or older? *

Yes
No

Have you been terminated from employment or asked to resign by an employer? *

Yes
No

If you answered yes to the question above, please provide detailed information:

Do you use tobacco products? (MERIL will only consider non-tobacco users as applicants for interview) *

Yes
No

If currently employed, may we inquire of your current employer?

Yes
No

If you answered yes to the question above, please provide your current employer's contact information (employer name, supervisor name and phone number)

How did you hear about MERIL or the current vacant position? *

Do you know any current MERIL employees? If so, please specify. *

What is the highest level of education you have completed? *

List any degrees or certificates you have obtained. Include name of school and date obtained. *

Employment History. Include your last seven years of employment, including periods of unemployment, starting with the most recent and working backwards in time. Include Company Name, Address, Role/Title and Dates Employed. *

Incomplete information may disqualify you from further consideration; falsified information will disqualify you from further consideration.

MERIL requires all applicants to be registered with the Missouri Family Care Safety Registry and undergo E-Verify certification. At the time of job offer, the selected candidate shall be asked to submit to drug testing. Refusal to agree shall result in a withdrawal of the job offer. Check the box below to indicate that you have read this notice. *

Yes, I have read this notice.

List any special skills, talent, experience or training that would enhance your ability to perform the position applied for. *

Describe your computer skills. *

Reference 1. List the name of a person not related to you whom you have known at least three years. Please provide name, address, phone number, email address, and a description of your relationship to the person. *

Reference 2. List the name of a person not related to you whom you have known at least three years. Please provide name, address, phone number, email address, and a description of your relationship to the person. *

Reference 3. List the name of a person not related to you whom you have known at least three years. Please provide name, address, phone number, email address, and a description of your relationship to the person. *

Please read carefully before agreeing. It is the policy of Midland Empire Resources for Independent Living (MERIL) not to discriminate on the basis of race, color, religion, national origin, sex (including pregnancy and wages related to gender), sexual orientation, disability, age, genetics, or veterans. I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Midland Empire Resources for Independent Living to hire me. If I am hired, I understand that either Midland Empire Resources for Independent Living or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Midland Empire Resources for Independent Living has the authority to make any assurance to the contrary. I attest with my signature below that I have given Midland Empire Resources for Independent Living true and complete information on this application. No requested information has been concealed. I authorize Midland Empire Resources for Independent Living to contact references provided for employment reference checks, to complete background checks and conduct drug testing. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for denial of employment or immediate dismissal. *

Yes, I have read these terms and I agree to them.

Type your full name below. This is your signature. *