Employment Application

APPLICATION FOR EMPLOYMENT

Midwest Assistance Program, Inc. (MAP) is an equal opportunity provider and employer and does not discriminate and all applicants are considered for all positions without regard to race, color, religion, age, sex, national origin, disability status, genetics, military or veteran status, sexual orientation, or any other protected classification, in accordance with applicable federal, state, and local laws. By completing this application, you are seeking to join a team of hardworking professionals dedicated to consistently delivering outstanding service to our customers and contributing to the financial success of the organization, its clients, and its employees. Equal access to programs, services, and employment is available to all qualified persons. Those applicants requiring accommodation to complete the application and/or interview process should contact a management representative.

* Indicates required field

Position(s) Applied for *

Date of Application *

First Name *

Middle Name *

Last Name *

Address *

City *

State *

Zipcode *

Phone Number *

Alternate Phone Number *

Email *

EMPLOYMENT EXPERIENCE
List the names of your present or previous employers in chronological order with present or most recent employer listed first. Be sure to account for all periods of time. If self-employed, give firm name and supply business references.

Name of Employer *

Supervisor *

May we contact? *

Address, City, & State *

Phone Number *

Dates Employed (Month/Year)

From *

To *

Job Title and Duties *

Reason for Leaving *

Name of Employer *

Supervisor *

May we contact? *

Address, City, & State *

Phone Number *

Dates Employed (Month/Year)

From *

To *

Job Title and Duties *

Reason for Leaving *

Name of Employer *

Supervisor *

May we contact? *

Address, City, & State *

Phone Number *

Dates Employed (Month/Year)

From *

To *

Job Title and Duties *

Reason for Leaving *

Have you ever been involuntarily terminated or asked to resign from any job? *

If yes, explain: *

Explain any gaps in your employment history: *

List any other experience, job related skills, additional languages, or other qualifications that you believe should be considered in evaluating your qualifications for employment. *

REFERENCES
List three professional references of individuals who are not related to you:

Name and Title *

Relationship *

Phone Number or Email *

Name and Title *

Relationship *

Phone Number or Email *

Name and Title *

Relationship *

Phone Number or Email *

EDUCATION
Describe your educational background below.

High School Name *

Years Completed *

Diploma *

College/University Name *

Years Completed *

Degree *

Area of Study/Major *

Graduate/Professional *

Years Completed *

Degree *

Area of Study/Major *

Trade School *

Years Completed *

Area of Study *

Other *

Years Completed *

Area of Study *

List any specialized training, skills, or extra-curricular activities here: *

Is there any additional information relative to name changes, assumed name, or nickname necessary to enable a background check? If so, provide additional information here: *

Have you worked for this company before? If yes, give dates and position: *

Are you available to work? *

If hired, would you have a reliable means of transportation to and from work? *

Can you travel if the position requires it? *

On what date are you available to begin work? *

Which state would you prefer to work in? *

Can you relocate if the position requires it? *

Are you at least 18 years old? Note if under 18, hire is subject to verification that you are of minimum legal age. *

If hired, can you present evidence of your identity and legal right to work in this country? *

Are you able to perform the essential job functions of the job for which you are applying with or without reasonable accommodation? *

Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for qualified applicants/employees to perform essential job functions.

Upload Resume File (optional) *

Max file size: 20MB

Upload Cover Letter File (optional) *

Max file size: 20MB

APPLICANT STATEMENT AND AGREEMENT:

I hereby authorize the Company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to the Company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure.
If I am employed by the Company, I understand that I am required to comply with all rules and regulations of the Company.
If hired, I understand and agree that my employment with the Company is at-will, and that neither I, nor the Company is required to continue the employment relationship for any specific term. I further understand that the Company or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications.
I understand that safety of employees is extremely important to the Company and that the Company is committed to ensuring a safe working environment. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my site supervisor. I understand and agree to comply with federal, state, and local regulations related to on-the-job safety and health.
I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration laws require me to complete an I-9 Form in this regard.
I understand that if any term, provision, or portion of this Agreement is declared void or unenforceable, it shall be severed and the remainder of this Agreement shall be enforceable.

Submitting my application indicates I have read, understand, and agreed to all of the above terms.

Submit

Central Office

309 E Summit Drive
Maryville, MO 64468
660-562-2575
map@map-inc.org

Contact
Staff Site

Our Mission:

Midwest Assistance Program, Inc., is dedicated to helping rural communities and tribal nations improve their environment, quality of life, and achieve self-sustainability.

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MAP is an equal opportunity provider and employer and does not discriminate on the basis of race, color, religion, age, sex, national origin, disability status, genetics, military or veteran status, sexual orientation, or any other protected classification, in accordance with applicable federal, state, and local laws.

APPLICATION FOR EMPLOYMENT

﻿Central Office﻿

Our Mission:

Central Office