* Required Information
Personal Information
Education
Restrictions
List any work limitations that you may have and briefly describe:
Availability for Work
Indicate Days and List Hours Available for Work:
Type of Work Seeking
Transportation
Abuse Investigation
Reference Information
Work Related #1
Work Related #2
Work Related #3
Personal #1
Personal #2

I certify that, to the best of my knowledge, the answers given are true and complete and that purposeful misrepresentation may result in rejection of my application. I authorize investigation of all statements contained in this application, as required. Additionally, I authorize former employers, references and any other individual/organizations to provide information to Mary’s Healing Hands and I hereby release and discharge any of the above and Mary’s Healing Hands from any liability of any kind or nature. I also understand that it is my responsibility to keep such information current and accurate by updating it as often as necessary.

I agree to a physical examination, if requested, and understand that failure to meet any medical and/or health requirements for the position may prevent my employment with the Agency. I also understand that employment, for certain positions, may be conditional upon successful completion of a substance abuse screening test and a criminal background check.

If further understand that, if hired, I may be required to provide proof that I am a citizen of the United States or proof that I am currently authorized to work in the United States.

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