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Application
Please provide the following information in the form:
Download Application
* = Required Information
Kirkland Ministries, Inc.
Application for Employment
Kirkland Ministries, Inc. is an Equal Opportunity Employment Opportunity Agency that strives to promote excellence through diversity in the workplace. Employment is offered based on qualifications and without regard to race, sex, religion, national or ethnic origin, disability, age, veteran status, or sexual orientation.
PLEASE TYPE OR PRINT. Complete the entire application. You may attach a resume, but you must still complete all questions, or your application will be deemed incomplete and may not be considered. Please fill out each box (don't just indicate “See Resume.”) Applications with missing or invalid job numbers will not be considered for any position.
*
Indicates required field
Position Applying For:
*
Behavioral Specialist #1000
Name
*
First
Last
Middle Name
*
Date of Birth (DOB):
*
Other names under which you have attended school or been employed:
*
Social Security Number:
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Home Phone
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Work Phone
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Other Phone
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Attach Resume
*
Max file size: 20MB
Are you eligible to work in the United States?
*
Yes
No
Are you at least 18 years of age or older?
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Yes
No
Are you currently employed at Kirkland Ministries, Inc.?
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Yes
No
Have you ever been employed by Kirkland Ministries, Inc.?
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Yes
No
Are you related to any current Kirkland Ministries, Inc. employee?
*
Yes
No
If required for position, do you have a valid driver’s license?
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Yes
No
How did you learn about this employment opportunity? (Check all that apply:)
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Ad in Newspaper
Dept. of Labor
Job Bulletin (Posting) /Walk-in
Referral by Employee
Website
Other
EDUCATION
High School
Name of School
*
City/State
*
Did you graduate?
*
Yes
No
Date of Graduation
*
No. of years left to graduate
*
Degree Received
*
Major
*
GED
Name of School
*
City/State
*
Did you graduate?
*
Yes
No
Date of Graduation
*
No. of years left to graduate
*
Degree Received
*
Major
*
Other School
Name of School
*
City/State
*
Did you graduate?
*
Yes
No
Date of Graduation
*
No. of years left to graduate
*
Degree Received
*
Major
*
College
Name of School
*
City/State
*
Did you graduate?
*
Yes
No
Date of Graduation
*
No. of years left to graduate
*
Did you graduate?
*
Yes
No
No. of years left to graduate
*
Degree Received
*
Major
*
College
Name of School
*
City/State
*
Did you graduate?
*
Yes
No
Date of Graduation
*
No. of years left to graduate
*
Degree Received
*
Major
*
College
Name of School
*
City/State
*
Did you graduate?
*
Yes
No
Date of Graduation
*
No. of years left to graduate
*
Degree Received
*
Major
*
Other credentials/ licenses/ professional affiliations, etc., which are relevant to the job(s) for which you are applying.
*
SKILLS: Please list technical skills, clerical skills, trade skills, etc., relevant to this position. Include relevant computer systems and software packages of which you have a working knowledge, and note your level of proficiency (basic, intermediate, expert).
Enter basic level here
*
Enter intermediate level here
*
Enter expert level here
*
WORK EXPERIENCE
Please detail your entire work history. Begin with your current or most recent employer. If you held multiple positions with the same organization, detail each position separately. Attach additional sheets if necessary. The Omission of prior employment may be considered falsification of information. Please explain any gaps in employment. Include full-time military or volunteer commitments. PLEASE DO NOT complete this information with the notation “See Resume.”
PLEASE NOTE: Kirkland Ministries, Inc. reserves the right to contact all current and former employers for reference information.
Dates Employed (most recent position)
From
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To
*
*
Part-time
Full Time
Title:
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Starting Salary:
*
Final Salary:
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Organization Name and Address:
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Supervisor's Name
*
Supervisor's Title
*
Supervisor's Phone #
*
Other Reference Name
*
Other Reference Title
*
Other Reference Phone #
*
Contact my current references:
*
At any time
Only if I am a finalist candidate
Primary duties:
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Reason for Leaving:
*
Dates Employed (most recent position)
From
*
To
*
*
Full Time
Part-time
Title:
*
Starting Salary:
*
Starting Salary:
*
Organization Name and Address:
*
Supervisor's Name
*
Supervisor's Title
*
Supervisor's Phone #
*
Other Reference Name
*
Other Reference Title
*
Other Reference Phone #
*
Contact my current references:
*
At any time
Only if I am a finalist candidate
Primary duties:
*
Reason for Leaving:
*
Dates Employed (most recent position)
From
*
To
*
*
Full Time
Part-time
Title:
*
Starting Salary:
*
Starting Salary:
*
Organization Name and Address:
*
Supervisor's Name
*
Supervisor's Title
*
Supervisor's Phone #
*
Supervisor's Name
*
Supervisor's Title
*
Supervisor's Phone #
*
Contact my current references:
*
At any time
Only if I am a finalist candidate
Primary duties:
*
Reason for Leaving:
*
Dates Employed (most recent position)
From
*
To
*
*
Full Time
Part-time
Title:
*
Starting Salary:
*
Final Salary:
*
Organization Name and Address:
*
Supervisor's Name
*
Supervisor's Title
*
Supervisor's Phone #
*
Other Reference Name
*
Other Reference Title
*
Other Reference Phone #
*
Contact my current references:
Contact my current references:
*
At any time
Only if I am a finalist candidate
Primary duties:
*
Reason for Leaving:
*
PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION.
I certify that the information on this application and its supporting documents are accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination of employment if discovered later. I authorize Kirkland Ministries Inc. to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers, without liability, to make a full response to any inquiries about this application for employment. If requested, I agree to submit to a physical exam, criminal background, credit background investigation (if applicable) and screening for illegal substances upon conditional offer of employment. I understand that this document is NOT an offer of employment (remove ,) and that an offer of employment (remove ,) if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that staff employees of Kirkland Ministries Inc. serve at-will, and the employment relationship may be terminated at any time by either party for any or no reason, other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the United States, to file a State security questionnaire and State loyalty oath, and to comply with company and departmental regulations. I understand that if employed on a temporary basis, payment is for hours worked only I would be paid for hours worked only, and would be ineligible for benefits including paid time off. If employed on a regular, benefits-eligible basis, I understand that I would be required to make mandatory contributions to the Kirkland Ministries Retirement System or to an optional retirement program, if applicable. I understand that any benefits I receive may be subject to change or discontinuation at any time without prior notice. I understand that the first SIX MONTHS of regular employment represent a provisional period, during which I would not be eligible to apply for transfer or promotion and during which I may be terminated without right of appeal.
Applicant Signature
*
Date
*
Submit
Home
About Us
Mission
Philosophy
Administration And Management
Kirkland Community Outreach
Services
Home and Community Based Services
Community Habilitation Services
Targeted Case Management and Rehabilitative Services for Children and Adolescents
Careers
Contact Us
Set An Appointment
Referral
Location and Direction
Donate
Giving Tuesday
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Giving Tuesday
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