Contact Us – Employment Opportunities

Please download and complete the following form

Fountains-Applications

Completed Applications for Assisted Living and Memory Care should be delivered in person to

15822 Clayton Road
Ellisville, MO 63011.

Or apply online now

PERSONAL DETAILS

Last Name

First Name

Middle Name

Social Security Number

Driver License Number

State Issued

Home Telephone

Cell telephone

Business Telephone

Email

Home Address

City

State

Zip

Mailing address if different than above

Home Address

City

State

Zip

Please list the cities and corresponding states in which you have lived for the past 7 years

For identification purposes, please provide

Month of Birth
Date of Birth:

Have you used any name(s) and/or social security number(s) other than that noted above?  Yes No

Please List Other Name(s) Used

Please List Other Social Security Number(s) Used

Are you at least 18 years old?  Yes No
if under 18 years of age, proof of minimum legal working age will be required if you are hired.

If hired, can you present evidence of your U.S. citizenship?  Yes No

If hired, would you have a reliable means of transportation to and from work?  Yes No

EMPLOYMENT INFORMATION

Position Desired

Are you applying for full-time work?  Yes No

Are you applying for part-time work?  Yes No

Are you applying for temporary work (e.g.summer holiday)?  Yes No

If applying for temporary work, during what period of time will you be available?
From:
To:

What days and hours are you available to work

Sunday
From
To:
Monday
From
To:
Tuesday
From
To:
Wednesday
From
To:
Thursday
From
To:
Friday
From
To:
Saturday
From
To:

Are you available to work on weekends? Yes No

Are you available to work overtime, if necessary?  Yes No

If hired, on what date can you start work?

Salary Desired

Have you ever applied to or worked for our company before?  Yes No

If yes, when?

Do you have any friends or relatives working for our company? Yes No

If yes, list name(s) and corresponding relationship

Do you have any commitment to another entity or person that might affect your employment with our company?  Yes No

If yes, please explain:

EDUCATION TRAINING

High School

Name:

City:

State

Did You Graduate?  Yes No
Degree or Diploma Attempted/Earned

Year Completed

College/University

Name

City

State

Did You Graduate?  Yes No
Degree or Diploma Attempted/Earned

Year Completed

Vocational School

Name

City

State

Did You Graduate?  Yes No
Degree or Diploma Attempted/Earned

Year Completed

SKILLS

Please answer the following in regards to your specific skills.

Typing Speed:

Ten Key Yes No

Shorthand Yes No

Spreadsheet Yes No

Graphics Yes No

Word-processing Yes No

Database Programs Yes No

Internet Research Skills Yes No

Managerial Yes No

List any computer programs and/or internet search engines with which you are familiar:

Please list any foreign languages you speak, read, write, and/or understand:

Please describe any other experience, training, qualifications, and/or skills that make you especially suited to work at our company:

EMPLOYMENT HISTORY

Are you presently employed?  Yes No

If yes, may we contact your present employer?  Yes No

Please provide a complete and accurate account of your employment history by listing all present and previous employers within the last ten years, beginning with your most recent employer. Please note that this section must be completed even if attaching a resume.
Furthermore, please be sure to attach any additional pages as needed.

Company 1

Company name

Type of Business

City/State

Company telephone

Supervisor Name/Title

Dates of Employment
From:
To:

Job Title

Earnings

Starting
 Hourly Monthly Yearly

Ending
 Hourly Monthly Yearly

Was your termination voluntary or involuntary?  Voluntary Involuntary

Please describe the exact reason for your termination:

Company 2

Company name

Type of Business

City/State

Company telephone

Supervisor Name/Title

Dates of Employment
From:
To:

Job Title

Earnings

Starting
 Hourly Monthly Yearly

Ending
 Hourly Monthly Yearly

Was your termination voluntary or involuntary?  Voluntary Involuntary

Please describe the exact reason for your termination:

Company 3

Company name

Type of Business

City/State

Company telephone

Supervisor Name/Title

Dates of Employment:
From:
To:

Job Title

Earnings

Starting
 Hourly Monthly Yearly

Ending
 Hourly Monthly Yearly

Was your termination voluntary or involuntary?  Voluntary Involuntary

Please describe the exact reason for your termination:

Company 4

Company name

Type of Business

City/State

Company telephone

Supervisor Name/Title

Dates of Employment:
From:
To:

Job Title

Earnings

Starting
 Hourly Monthly Yearly

Ending
 Hourly Monthly Yearly

Was your termination voluntary or involuntary?  Voluntary Involuntary

Please describe the exact reason for your termination:

UNEMPLOYMENT HISTORY

Please account for all times of unemployment during the last ten years,after completing school, by listing both the exact period(s) of time and the corresponding reasons for unemployment. Please do not include periods of unemployment of one month or less.

PROFESSIONAL REFERENCES

List below three persons not related to you, from either a business or academic settings, who have knowledge of your professional performance abilities within the last three years.

1

Reference Name


Relationship


Years Known


Company/Institution Name


Telephone

2

Reference Name


Relationship


Years Known


Company/Institution Name


Telephone

3

Reference Name


Relationship


Years Known


Company/Institution Name


Telephone

LICENSE INFORMATION

License/Certificate Name


License/Certificate Number


State Issued


If your license/certificate has ever lapsed, been revoked or suspended, please explain:

MILITARY SERVICE

Branch of Service


Dates of Enlistment:

From


To


Rank Attained


Are you presently a member in the National Guard or Reserves? Yes No

If yes, list the date your obligation ends


Please describe any special skills you have obtained as a result of your service in the military:

ATTENDANCE HISTORY

Is there any reason you would not be able to fully conform to all attendance requirements?  Yes No

If yes, please explain:
>
How many Mondays and/or Fridays were you absent last year, other than vacation leave?


Please Explain

CRIMINAL HISTORY

Please respond to the following questions in the most complete and accurate manner possible. Do not identify convictions for convictions for which the criminal record has been expunged or sealed by the court; or, misdemeanor convictions for which any probation has been completed and the case dismissed by the court. Furthermore, please note that no applicant will be denied employment solely on the grounds that they have been charged, committed, or convicted of (or pleaded guilty or no contest to) a criminal offense; or, solely on an affirmative answer. The nature, date, surrounding circumstances, and relevance of the offense to the position(s) applied for will be considered.

Have you ever, under your name or another name, been convicted of (or pleaded guilty or no contest to)a felony or misdemeanor?  Yes No

Have you ever, under your name or another name, been convicted of a crime which resulted in your beingin prison and/or jail and released from prison and/or jail or paroled?  Yes No

If yes to either question noted above, please fully explain when, where and of what you were convictedand the result of the case(s)


Are you currently under arrest, or released on bond on your own recognizance, pending trial for a criminal offense?  Yes No

If yes, state the nature of the crime charged, and when and where the trial is pending:


Have you used illegal drugs in the last six months? Yes No

Do you take any illegal drugs or medications which have not been prescribed for you? Yes No

If yes to either of the above questions, when was the last time you used illegal drugs?


Please explain:


Have you ever been convicted of driving under the influence (DUI)?  Yes No

Do you use alcohol to the extent that it would impair your job performance?  Yes No

Are you able to perform the essential functions of the job you are applying for (with or without reasonable accommodation) ?  Yes No

If no, describe the functions that cannot be performed:

Thank you for completing this application.
If there is a current opening for the position(s) you are seeking, and the information in your application suggests you meet minimum qualifications and are among the best qualified candidates for that position, you may be contacted for an interview. If you are interviewed, you will be informed of a final decision once the entire interview process is completed, which includes a complete background check and pre-employment drug test.
If there is no opening for the position(s) you are seeking, your application will be kept active for 30 days. If you wish to be considered for employment after that time, you must reapply.
Thank you for your interest in our company.

Privacy Notice

This privacy notice discloses the privacy practices for fountainsofwestcounty.com. This privacy notice applies solely to information collected by this website. It will notify you of the following:

  1. What personally identifiable information is collected from you through the website, how it is used and with whom it may be shared.
  2. What choices are available to you regarding the use of your data.
  3. The security procedures in place to protect the misuse of your information.
  4. How you can correct any inaccuracies in the information.
  5. How policy changes will be communicated.

Information Collection, Use, and Sharing

We are the sole owners of the information collected on this site. We only have access to/collect information that you voluntarily give us via email or other direct contact from you. We will not sell or rent this information to anyone.

We will use your information to respond to you, regarding the reason you contacted us. We will not share your information with any third party outside of our organization, other than as necessary to fulfill your request.

Unless you ask us not to, we may contact you via email in the future employment opportunities, or changes to this privacy policy.

Your Access to and Control Over Information

You may opt out of any future contacts from us at any time. You can do the following at any time by contacting us via  info@fountainsofwestcounty.com

  • See what data we have about you, if any.
  • Change/correct any data we have about you.
  • Have us delete any data we have about you.
  • Express any concern you have about our use of your data.

Security

We take precautions to protect your information. When you submit sensitive information via the website, your information is protected both online and offline.

Changes to this Policy

We may make changes to this privacy notice from time to time. You may check back on this page at any time to see our current policy.

If you feel that we are not abiding by this privacy policy, you should contact us immediately via telephone at info@fountainsofwestcounty.com