Back Up Home Manager, Uniontown Group Home
Requires a high school diploma and a valid AL driver's license.
Must be able to be MAC certified.
Full Time or Part Time
May we contact your current employer?
When can you begin?
Desired starting salary?
Start with your present or last job. List all employment experience. Email additional jobs or resume to [email protected].
Date Employed From
Date Employed To
Reason for Leaving
Name of School
Other than Relatives
List any other factors which you feel might be important in your application for employment including typing, office machines used, professional licenses and/or certificates, and any other experience or training not covered in the application elsewhere.
Have you ever been denied coverage under an employee fidelity bond?
Applicants for Clinical Positions:
Have you ever had your professional license suspended or revoked, or have you ever been disciplined by your license board?
Applicants for Positions that Include Driving:
Do you have a medical condition that restricts your driving ability (i.e., Insulin dependent, seizures, sight problems, etc.)?
If yes, please explain:
I certify that the answers given to the foregoing questions are true and correct without consequential ommissions of any kind whatsoever. I understand that any false or misleading statements are grounds for dismissal and shall not hold the Mental Health Center liable in any respect if my employment is terminated because of said falsification or omissions made by me in the questionnaire. I authorize the employers (with the possible exception of current employer), schools or persons named herein to give any information regarding my employment or physical condition, together with any information they may have regarding me whether or not it is in their records. I hereby release said employers, schools, or persons from all liability for any damage for issuing this information. If accepted for employment, I hereby authorize my participation in any group insurance and/or retirement plans for which I am eligible and in which participation is a condition of employment. I further agree to abide by all policies of the Cahaba Center.
Full Legal Name
Note: Any item on this form which you feel tends to violate Federal or State Civil Rights of FEPC Legislations need not be completed. We are an Equal Opportunity Employer. A copy of this application is available to you on request.