JOB APPLICATION

1Application for Employment

2Education

3Employment

4Skills & References

5Final Submission

Many Rivers Whole Health is an equal opportunity employer.

All job offers of employment at Many Rivers Whole Health are contingent upon clear results of a thorough background check, Urine Analysis test, motor vehicle records, and references. If you need reasonable accommodations to ensure your full participation in completing this application, please contact human resources.

Application

Name *

First

Middle

Last

Address *

Address Line 1

City

State

Zip Code

Phone *

Email *

Social Security Number *

Position Desired *

Have you been employed with us before?

If yes, give dates

Which location do you want to work at?

Great Falls
Helena
Havre
Conrad
Boulder
Chinook
Chocteau
Cut Bank
Shelby
Townsend
Whitehall

How did you hear of this position?

When would you be able to begin work?

Have you ever been convicted of a felony?

If yes, please explain. If you have been convicted of a felony, it does not mean that you automatically will not be considered for a position.

Have you ever received a job-related disciplinary action or been fired?

If yes, please explain.

State standards require employees who work with mentally ill adults and children to be at least 18 years of age. Are you at least 18 years of age?

Many Rivers Whole Health is an equal opportunity employer.

A pre-employment drug screening test will be conducted. If you need reasonable accommodations to ensure your full participation in completing this application, please contact human resources.

High School

High School Name and Location

Number of years completed

Did you graduate?

Diploma or GED

Diploma
GED

Business or Trade School

School 1: Name and Location

From Date

To Date

Course of Study

Number of years completed

Did you graduate?

Degree or Diploma

Degree
Diploma

School 2 (if applicable)

Name and Location

From Date

To Date

Course of Study

Number of years completed

Did you graduate?

Degree or Diploma

Degree
Diploma

College

Name and Location

From Date

To Date

Course of Study

Number of years completed

Did you graduate?

Degree or Diploma

Degree
Diploma

School 2 (if applicable)

Name and Location

From Date

To Date

Course of Study

Number of years completed

Did you graduate?

Degree or Diploma

Degree
Diploma

Graduate School

Name and Location

From Date

To Date

Course of Study

Number of years completed

Did you graduate?

Degree or Diploma

Degree
Diploma

School 2 (if applicable)

Name and Location

From Date

To Date

Course of Study

Number of years completed

Did you graduate?

Degree or Diploma

Degree
Diploma

Education Documents

Please upload your transcripts and diploma or degree for the highest level of education completed

Click or drag files to this area to upload. You can upload up to 4 files.

This is not mandatory, but is required documentation if you are selected for the position for which you are applying.

Many Rivers Whole Health is an equal opportunity employer.

A pre-employment drug screening test will be conducted. If you need reasonable accommodations to ensure your full participation in completing this application, please contact human resources.

Employment

Company Name

Address

Address Line 1

City

State

Zip Code

Phone

From Date

To Date

Name of Supervisor

Job Title

Describe Your Work

Reason for Leaving

Highest Salary

May we contact?

Job 2

Company Name

Address

Address Line 1

City

State

Zip Code

Phone

From Date

To Date

Name of Supervisor

Job Title

Describe Your Work

Reason for Leaving

Highest Salary

May we contact?

Job 3

Company Name

Address

Address Line 1

City

State

Zip Code

Phone

From Date

To Date

Name of Supervisor

Job Title

Describe Your Work

Reason for Leaving

Highest Salary

May we contact?

Job 4

Company Name

Address

Address Line 1

City

State

Zip Code

Phone

From Date

To Date

Name of Supervisor

Job Title

Describe Your Work

Reason For Leaving

Highest Salary

May we contact?

We will contact the employers listed above unless you indicate those you do not want us to contact.

Many Rivers Whole Health is an equal opportunity employer.

A pre-employment drug screening test will be conducted. If you need reasonable accommodations to ensure your full participation in completing this application, please contact human resources.

Skills

List any skills or volunteer work that would help qualify you for this position (i.e. machines you can operate, computer, typewriter, calculator, computer programs you know, etc.).

List any special licenses, registrations or training, including seminars and workshops, which help you qualify for the position.

Professional References

Please list three additional professional references

Name *

Title *

Address *

Address Line 1

City

State

Zip Code

Phone *

Reference 2

Name *

Title *

Address *

Address Line 1

City

State

Zip Code

Phone *

Reference 3

Name *

Title *

Address *

Address Line 1

City

State

Zip Code

Phone *

Many Rivers Whole Health is an equal opportunity employer.

A pre-employment drug screening test will be conducted. If you need reasonable accommodations to ensure your full participation in completing this application, please contact human resources.

Resume

Please upload your resume or cover letter, if desired

Click or drag files to this area to upload. You can upload up to 2 files.

Pre-Employment Criminal Background Investigation Policy (copy)

Applicants for employment with Many Rivers Whole Health are subjected to reference checks with former employers and/or managers. Educational credentials are subject to verification. Applicants for positions of trust over children, vulnerable adults or persons with disabilities must have criminal background checks. Applicants that will transport clients will have their driving records inspected. Any offer of employment or appointment to a position is contingent upon a satisfactory criminal background and driving record. Any decision to accept or reject an individual with a conviction or pending indictment is solely at the discretion of Many Rivers Whole Health. (All related information will be treated as confidential, and protected as such.) The decision to reject or terminate an individual with an unreported conviction or pending indictment is solely at the discretion of Many Rivers Whole Health. All results of criminal and sex and violent offender convictions or issues are considered confidential and will be maintained in confidential files within the Human Resources area. Only individuals in Human Resources, who are authorized to do so, may initiate or receive a criminal background check. Information gained from any of the above background checks will be held in confidence and shared with management individuals only on a need-to-know basis.

An Authorization for Pre-Employment Criminal Background Investigation must be completed.

Position Applying For *

Download your background check authorization form

Download here

Please upload your background check authorization information *

Click or drag files to this area to upload. You can upload up to 2 files.

The information provided in this Application for Employment is true, correct, and complete. If employed, any mis-statement or omission of fact on this application may result in dismissal. In understand the acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employment in the future. I hereby authorize the Center for Mental Health to contact prior employers to release job-related information related to my past work performance. I authorize all former employers to release job-related information they may have about me to the Center for Mental Health. I release all persons or companies from any liability or responsibility for providing such information. I authorize the Center for Mental Health, and their agent, to obtain information related to past employment, employers, school activities, verification of education, criminal justice agencies, motor vehicle/registration departments, professional licensing registries, or other relevant sources of information. This information may include, but is not limited to, information about my academic achievement, performance, attendance, disciplinary, employment history, criminal history record information, driving and motor vehicle record. I authorize custodians of records and other sources of information pertaining to me, to release such information to Center for Mental Health, regardless of any previous agreement to the contrary. I release my previous employer, its officers, employees and agents, from any liabilities resulting from release of such information.

Please enter your name as a signature *

Date *

This information is voluntary to complete, and not required for submitting your application. It is completely confidential. Should you decide to disclose this information, it will in no way be used to make any employment decisions.

Gender identity

Female
Male
Non-binary
Prefer not to answer

Preferred Pronouns

She/Hers
He/His
They/Them

Ethnicity

WHITE (Not of Hispanic origin). All persons having origins in any of the original peoples of Europe, North Africa or the Middle East.
BLACK (Not of Hispanic origin). All persons having origins in any of the black racial groups of Africa.
HISPANIC. All persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.
ASIAN OR PACIFIC ISLANDER. All persons having origins in any of the original peoples of the Far East, Indian.
AMERICAN INDIAN OR ALASKA NATIVE. All persons having origins in any of the original peoples of North America.

The preceding information is used to statistically determine if the Center's selection procedures are adversely affecting employment opportunities. The survey information is kept confidential, and no hiring manager has access to said information. Failure to provide this information will NOT jeopardize or adversely affect your consideration for employment.

Veterans and Individuals with Physical or Mental Disabilities

Disabled Veteran
Recently Separated Veteran
Other Protected Veteran
I am NOT a Veteran

Are you a disabled individual?

A disabled individual means any person who (a) has a physical or mental impairment that substantially limits one or more major life activities; (b) has a record of such impairment; or (c) is regarded as having such an impairment.

Are there any accommodations that we could make that would enable you to preform the job properly and safely?

If yes, please explain:

If you are a veteran, or have a physical or mental disability, you are invited to volunteer this information. The purpose is to provide information regarding proper placement and appropriate accommodation to enable you to perform the job to the best of your ability, in a safe and proper manner. The survey information is kept confidential, and no hiring manager has access to said information. Failure to provide this information will NOT jeopardize or adversely affect your consideration for employment.

Please enter your name as a signature *

Date *

Comment