Have you ever been convicted of a felony?
Are you a smoker?
Are you CPR certified?
Do you have a 1st AID Certification?
Are you Certified to Administer Medication?
MANDT or CPI
What do you think are your strongest qualities, skills, and abilites? (Note: at the end of each line, move to the next one.)
What do you think you would like to accomplish by working in the MR/DD field? (Note: at the end of each line, move to the next one.)
Did you watch the video?
Address (Hour Number, Street, City, State, Zip Code)
Email Address (required)
Position you are applying for (be specific)
Days/Hours available to work: (most shift and in the evenings and weekends)
Type of Employment Desired
Drivers License (number, state, expiration date)
Have you driven a full size van?
Number of moving violations in the past three years (tickets/accidents)
Do you have a disabling condition that would inhibit driving?
Have you ever been denied a driver's license?
If yes, give dates and explain:
Have you ever worked at CDD before? If yes, please state when and position(s) held
Are you authorized to work in the U.S.
How soon would you be available to work?
Name, Address and Phone Number of person to contact in case of emergency:
# of years completed
Did you graduate?
What was your degree
Most Recent Organization Name:
Dates Employeed (month/year)
May we contact this employer?
Reason for leaving:
Brief description of duties:
Dates employed (month/year)
May we contact this employeer?
Dates Employed (month/year)
Phone Number (required)
Social Security #
Name (Last, First, Middle Initial)
Social Security Number
Please list all education beginning with most recent.
EDUCATION, TRAINING & CERTIFICATIONS
List all employment including military and volunteer services starting with the most current position held. Show employment history for at least 10 years or from the time you left school. You may attach certificates or a resume to supplement the information.
Attach your resume here:
DO NOT INCLUDE PAST SUPERVISORS OR FAMILY MEMBERS. By listing these references, you are giving CDD permission to contact these people and release CDD from liability for using information given for employment purposes.
I understand and agree that:
CENTER FOR DEVELOPMENTALLY DISABLED IS AN EQUAL OPPORTUNITY EMPLOYER
APPLICANT - COMPLETE BEFORE SUBMITTING
I hereby authorize the employer listed below to provide information regarding my employment to the Center for Developmentally Disabled. I release you and CDD from and and all liability from damages for providing/using the information requested for employment purposes.
Application for Employment
1.) Personal Information
3.) Employment History
4.) Personal References
5.) Reference Check
1010 W. 39th St.KC, MO 64111T. 816-531-0045F: 816-756-5612www.cddkc.org