Community Counseling Center

 
 
402 S. Silver Springs Road Cape Girardeau, MO 63703 (573) 334-1100 www.cccntr.com
  
     
 

Employment Application

  
     
  Community Counseling Center is an Equal Opportunity Employer. Race, color, religion, age, sex, disability, marital or veteran status, place of national origin and other categories protected by law are not factors in employment, promotion, compensation or working conditions.  
     
 
 
     
 
Personal (Please Print Plainly) Date__________________________________
   
Name________________________________

Address_______________________________

City/State____________________________

Telephone umber______________________

 SSN___________________________________

______________________________________

Zip Code______________________________

Message Number_______________________
   
 
  Have you ever worked for Community Counseling Center before?    Yes    No  
     
 
If yes,when?__________________________ Name Employed By_____________________
 
     
  Have you ever applied for a position at Community Counseling Center before? Yes    No  
     
  List any friends or relatives working for us________________________________________  
     
  Have you ever been convicted or pled guilty to a misdemeanor or felony charge which shall include any suspended imposition of sentence, any suspended execution of sentence or any period of probation or parole?    Yes    No  
     
  If yes, describe in full ________________________________________________________  
     
  (NOTE: Community Counseling Center conducts background checks on all new employees in accordance with Missouri law. No applicant will be denied employment solely on the grounds of a conviction of a criminal offense. The nature of the offense the date of the offense, the surrounding circumstances and the relevance of the offense to the position (s) applied for may, however, be considered.)  
     
  Position applying for__________________________________________________________  
     
  Full Time    Part Time    Temporary     
     
 
Minimum salary desired_________________ Date Available for Employment____________
 
     
  Are you able to perform the essential functions of the job you are applying for? Yes  No  
     
 

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