Please enable JavaScript in your browser to complete this form.Personal DataName *FirstLastEmail *Phone *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeJob InterestPosition Applied For: *Available to startType of employmentFull timePart timePRNShift(s)DaysEveningsNightsLegally allowed to work in US? *NoYesAvailable to work weekends?NoYesHave you ever been convicted of a crime other than a misdemeanor? *YesNoIf Yes, briefly explain any conviction and include any pending charges:Has your professional license ever been disciplined, suspended, or revoked?YesNoIf Yes, briefly explain discipline, suspension, or revocation:If you were referred by a current employee enter their name here:EducationHigh School Name:Did you graduate high school?NoYesYear?College/University Name:Did you graduate college?NoYesYear?Other Education:Employment HistoryList most recent employer first#1 Company Name:PhoneType of BusinessEmployed from when to when?Supervisor Name and TitlePosition heldEnding WageReason for leaving#2 Company NamePhoneType of BusinessEmployed from when to when?Supervisor Name and TitlePosition heldEnding wageReason for leaving#3 Company NameCompany AddressPhoneType of BusinessEmployed from when to whenSupervisor name and titlePosition heldEnding wageReason for leavingUpload your resume - optional Click or drag a file to this area to upload. Upload a cover letter - optional Click or drag a file to this area to upload. Professional ReferencesPlease enter name, company, title, and phone numberReference #1Reference #2Reference #3AgreementI understand that Cottages of Lake St Louis has a commitment to maintain a drug-free workplace and that, unless prohibited by law, requires a drug-screening test as part of its selection and hiring process. If after a second, confirmatory test it is determined my specimen contains a prohibited controlled substance, or was altered or substituted, I will be disqualified from consideration and any offers of employment withdrawn.As a part of this application process I hereby authorize Cottages of Lake St Louis to investigate my background and qualifications for purposes of evaluating whether I am qualified for the position for which I am applying. I understand that Cottages of Lake St Louis will utilize an outside firm or firms to assist it in checking such information, and I specifically authorize such an investigation by information services and outside entities of the company's choice. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application for employment will not be processed further.Cottages of Lake St Louis provides a list of new hires to the Missouri Department of Employment Security for unemployment and garnishment purposes. I declare that the facts set forth in my application are true and complete. I understand that if I am employed, false information stated in this application shall be sufficient cause for dismissal. SignatureClear SignaturePhoneSubmit