MCDS. Inc Employment Application

In compliance with federal and state equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, age, national origin, marital status and/or disability. Equal access to programs, services, and employment is available to all persons. Those applicants requiring accommodations to the application and/or interview process should contact the personnel department. Applications will be kept on file for 30 days.

Date of Application *

- Month - Day Year

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Fill out the online employment application *

Full Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

- Area Code Phone Number

E-mail *

Over 17 years of age? *

Employment Details

Position applied for - Check all that apply. *

Direct Care Supervisor Case Manager Office

Certifications - Check all the apply. *

CNA CMA CPR First Aid N/A

Employment *

Shift Preference *

Current Drivers License? *

Have you previously been employed by MCDS? *

Education

Highest Grade Achieved *

1. Name of School *

State (e.g. Ks) *

Most Recent Employer

Employer *

Phone Number *

- Area Code Phone Number

Employed From (mm/yyyy) *

Employed To (mm/yyyy) *

Reason for Leaving *

May we contact your employer? *

Yes No

Previous Employment *

Employer *

Phone Number *

- Area Code Phone Number

Employed From (mm/yyyy) *

Employed To (mm/yyyy) *

Reason for Leaving *

May we contact your employer? *

Yes No

Other Employment *

Employer *

Phone Number *

- Area Code Phone Number

Employed From (mm/yyyy) *

Employed To (mm/yyyy) *

Reason for Leaving *

May we contact your employer? *

Yes No

List Two Work References

Full Name *

First Name Last Name

Phone Number *

- Area Code Phone Number

Full Name *

First Name Last Name

Phone Number *

- Area Code Phone Number

Describe any special skills, abilities and/or characteristics that you believe may be important as an applicant to MCDS Inc *

Referred By

If I am selected for employment with Multi Community Diversified Services Inc. (MCDS), I acknowledge and understand that I must submit to required appropriate background checks to ensure that no employee has a history of abuse, neglect and/or exploitation of children or vulnerable adults.

My acceptance of an offer of employment with MCDS in no way creates a contractual obligation. I agree to conform to the policies of MCDS. I understand my employment and compensation may terminate with or without cause, with or without notice, any time by either MCDS or myself. I understand that MCDS is an "at will" employer.

I UNDERSTAND THAT AS AN M.C.D.S. EMPLOYEE, I WILL FREQUENTLY BE IN CLOSE CONTACT WITH CLIENTS. I UNDERSTAND THAT SOME POSITIONS MAY REQUIRE PHYSICAL ACTIVITY SUCH AS LIFTING, BENDING, PUSHING, PULLING, WALKING, STANDING, AND SITTING. I ALSO UNDERSTAND THAT I MAY BE REQUIRED TO ASSIST CLIENTS WITH DAILY FUNCTIONS, PERFORM ACTS OF CARE, AND CONDUCT FIRST AID OR CPR. TO THE BEST OF MY KNOWLEDGE, I DO NOT HAVE ANY CONDITION OR LIMITATION THAT WOULD RESULT IN A DIRECT THREAT TO OTHERS OR THAT WOULD INHIBIT MY ABILITY TO PERFORM THE FUNCTIONS OF MY POSITION WITH OR WITHOUT A REASONABLE ACCOMODATION.

By clicking SUBMIT I acknowledge having read the above, I certify the information contained herein is true and complete to the best of my knowledge. I authorize the investigation of all statements contained in this application. In the event I am employed by MCDS I understand the discovery of false or misleading information, given in this application or interview, may result in my immediate termination