Staff Application — Kindway Center

Position & Availability

Tell us about the role you're interested in and when you can start.

Position applied for *

Application date *

Date available

Pay expectation

Employment status desired

Full time Part time PRN / relief

Shifts available (check all that apply)

List specific days/hours available and any scheduling limitations

How did you hear of us?

Applicant Information

Your legal name and contact details.

Legal last name *

Legal first name *

Middle name

Preferred name

Street address *

Apt./Unit

City

State

ZIP code

Primary phone *

Email address *

Date of birth *

Social Security number *

Date of birth and Social Security number are collected for identity verification and required pre-employment screening, and will be treated as confidential.

Other legal name(s) used

If previously applied or employed, provide date and position

Qualifications & Screening

Kindway Center provides 24-hour services to female minors with intellectual and developmental disabilities. Certain positions require direct care, active treatment, supervision, transportation, documentation, medication support, and response to behavioral or medical emergencies.

Explain any "No" response above, or describe any accommodation you wish to request (do not disclose a diagnosis)

Licenses, Certifications & Registries

Credential / certification

Number

State

Expiration

Credential / certification

Number

State

Expiration

Current certifications (check all that apply)

Other relevant license, certification, registry status, or specialized training

Education & Training

Your educational background and relevant experience.

High School / GED

School name and location

Course of study

Diploma / degree

College / University

School name and location

Course of study

Diploma / degree

Trade / Technical / Other

School name and location

Provide three professional references who are not relatives. Include at least one former supervisor when possible.

Reference 1

Name

Professional relationship

Phone

Email

Years known / organization

Reference 2

Name

Professional relationship

Phone

Email

Years known / organization

Reference 3

Name

Professional relationship

Phone

Email

Years known / organization

Employment & Conduct Information

Are you currently employed?

YesNo

May we contact your current employer?

YesNo

Ever discharged, asked to resign, or left employment under investigation?

YesNo

Related to, or in a close personal relationship with, any Kindway Center employee, contractor, volunteer, or board member?

YesNo

If yes above, explain. An affirmative response does not automatically disqualify you.

If related to a Kindway Center team member, identify the person and relationship

Provide any other job-related information you would like Kindway Center to consider

Certification & Authorization

Important notice: Final candidates may be required to complete job-related background screening appropriate to work in a licensed healthcare setting serving minors. This may include criminal history, healthcare personnel registry, sex offender registry, exclusion/debarment, driving record, education or credential verification, employment references, drug screening, and other checks required by law, payer, licensing authority, or Kindway Center policy. Any separate consumer report authorization and required disclosures will be provided as standalone documents.

I authorize Kindway Center to verify job-related information and conduct the background, registry, exclusion, credential, reference, and driving-record checks applicable to the position. I understand that any consumer report requiring a standalone disclosure and authorization will be presented separately. * I certify that the information in this application and any attachments is true, complete, and accurate to the best of my knowledge. I understand that material false statements, omissions, or misrepresentations may disqualify me from consideration or result in termination if discovered after employment. * I authorize Kindway Center to contact the employers, schools, licensing bodies, and professional references identified in this application to verify job-related information, except where I have expressly requested that a current employer not be contacted. * I understand that employment with Kindway Center is at will unless a written agreement signed by an authorized Kindway Center representative states otherwise. At-will employment may be ended by either party at any time, with or without notice, subject to applicable law. * If hired, I agree to follow Kindway Center policies, resident rights requirements, confidentiality obligations, safety procedures, active treatment expectations, and lawful instructions. * I understand that employment is contingent upon completing all pre-employment requirements applicable to the position. * I understand that this application remains active for 90 days unless Kindway Center states otherwise. *

Electronic Signature

Typing your full legal name below serves as your electronic signature and confirms your agreement to the certification above.

Applicant's legal name (electronic signature) *

Date *

Applicant initials *

Optional application ID

Applications are sent securely to kindwaycenter@gmail.com.

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