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COMMUNITY MENTAL HEALTH AUTHORITY - Application for Employment

The Community Mental Health Authority does not discriminate on the basis of race, color, religion, national origin, sex, age, height, weight, disability, or any other status protected by federal or state law or regulation. It is our intention that all qualified applicants be given equal opportunity and selection decisions be based on job-related factors. If you need assistance in completing this form because of disability, special accommodation for applications in alternative formats are available upon request.
  • Specify any days or times you are NOT available for work:
  • What shift(s) are you willing to work?
  • Date Available for Work:
  • If previously employed by Community Mental Health
  • If previously employed by Community Mental Health
  • If previously employed by Community Mental Health
  • if previously employed by Community Mental Health
  • If yes, please include dates of service.
  • Employment History

    List your last four employers, or all employers for the last ten years, whichever is greater. Attach additional signed sheets if necessary. Also list and explain any period(s) of unemployment. Please answer all inquiries. "See Resume" is not acceptable
  • month and year
  • Former Employer 1

  • month and year
  • Former Employer 2

  • month and year
  • Former Employer 3

  • month and year
  • Professional/Work References:

  • Personal References (not related to you)

  • Education

  • PROFESSIONAL LICENSES, REGISTRATIONS, AND/OR CERTIFICATIONS

Please wait for confirmation message after submitting your application. If you do not receive the confirmation, your application was not successfully submitted.