Applicant Details

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Cover Letter, Resume, & References

Click or drag files to this area to upload. You can upload up to 3 files.

Position Details

Position Applying For: *

Program Guide - Asheville
General Inquiry

Date available for work: *

Background Information

Have you ever been employed by MountainCare? *

Yes
No

If yes, when?

Do you have a valid Drivers License? *

Yes
No

If yes, please enter your License Number/State:

Have you ever been convicted of any civil/criminal violation, other than minor traffic violations? *

Yes
No

If yes, please explain:

Have you ever had a professional license suspended or revoked by a regulatory agency? *

Yes
No

If yes, please explain:

Are you currently under any investigation or pending charge? *

Yes
No

If yes, please explain:

Are you a citizen of the United States? *

Yes
No

If you are not a citizen of the United States, are you legally eligible for employment in the United States?

Yes
No

If yes, what type of work visa do you currently have?

Educational Background

List the last two schools you attended, the number of years completed, degree(s) received (if any), and any major(s) and/or minors.

1. Name of school: *

Number of years attended: *

Degree(s):

Major(s) and Minor(s):

2. Name of school:

Number of years attended:

Degree(s):

Major(s) and Minor(s):

Work Experience

List your last three employers starting with the most recent. Explain any gaps in employment that may exist. Please identify any employer whom you do not want us to contact for a reference.

Employer #1 *

Address

Phone *

Your Title at Employer #1 *

Supervisor Name *

First

Last

Dates of employment: *

Job duties: *

Reason for leaving: *

May we contact for a reference? *

Yes
No

Employer #2

Address

Phone

Your Title at Employer #2

Supervisor Name

First

Last

Dates of employment:

Job duties:

Reason for leaving:

May we contact for a reference?

Yes
No

Employer #3

Address

Phone

Your Title at Employer #3

Supervisor Name

First

Last

Dates of employment:

Job duties:

Reason for leaving:

May we contact for a reference?

Yes
No

Applicant's Statement

I certify that the information I have supplied on this application is true and complete. I understand that any misrepresentation by me on this application or during the interview process will cause me to be ineligible for employment and grounds for immediate termination of employment from the company. I authorize the company to investigate all references and to secure additional job-related information about me. I hereby release the company from liability for seeking such information and all other persons, corporations and/or organizations for furnishing such information. If employed, I understand and agree that my employment can be terminated, at any time and for any reason, at the option of either the company or myself, with or without prior notice.

Signature *

Thank you for applying!

Once this form is submitted, a member of our team will review it. There is no guarantee that you will be chosen for an interview or offered a job as a result of the completion of this form. Your application will be compared with other candidates' applications to determine who will be invited for a personal interview. Again, thank you for your interest in employment with MountainCare!