Become an Angel - Angels on Duty

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Applicant Information

Name*

First Middle Initial Last

Previous Last Names

Email*

Home Phone*

If you only have a cell phone, enter it here.

Cell Phone

Leave blank if your cell number is Home Phone.

Current Address*

Street Address Address Line 2 City State ZIP Code

Are you 18 years or older?*

Yes

Are you prevented from lawfully becoming employed in this country because of VISA or immigration status?*

Yes

Do you have a current driver's license without restrictions?*

Yes

Please enter your driver's license number*

Have you been convicted of or plead guilty to any traffic related offense within the past five (5) years?*

Yes

Have you had your driver's license suspended, revoked, or had your driving privileges modified by a court of law?*

Yes

Have you ever been convicted or pled guilty to a felony or other crime?*

Yes

Please explain:*

Position Information

All Angels are paid an hourly rate based on the type of work. Please see Our Rates for more information.

Position Desired:*

Nurse Aide

LPN, RN

Date You Can Start:*

MM slash DD slash YYYY

Are you currently employed?*

Yes

Have you applied to this company before?*

Yes

Please specify:*

MM slash DD slash YYYY

How did you hear about angels on duty?*

Friend works there

Ad in the paper

Other

If Other, please specify:

Education

High School

Location

# of Years

Graduate?

Yes

Degree / Subjects Studied

College

Location

# of Years

Graduate?

Yes

Degree / Subjects Studied

Trade, Business, or Correspondence School

Location

# of Years

Graduate?

Yes

Degree / Subjects Studied

Other

Location

# of Years

Graduate?

Yes

Degree / Subjects Studied

Former Employers

List all of your last 5 employers, starting with the most recent first.

Employer #1

Employer Name

Phone Number

Job Title

Hourly Rate

Start date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Leave blank if still employed here

May We Contact?

Yes

Reason For Leaving

Employee #2

Employer Name

Phone Number

Job Title

Hourly Rate

Start date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Leave blank if still employed here

May We Contact?

Yes

Reason For Leaving

Employee #3

Employer Name

Phone Number

Job Title

Hourly Rate

Start date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Leave blank if still employed here

May We Contact?

Yes

Reason For Leaving

Former Employers (cont)

List all of your last 5 employers, starting with the most recent first.

Employee #4

Employer Name

Phone Number

Job Title

Hourly Rate

Start date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Leave blank if still employed here

May We Contact?

Yes

Reason For Leaving

Employee #5

Employer Name

Phone Number

Job Title

Hourly Rate

Start date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Leave blank if still employed here

May We Contact?

Yes

Reason For Leaving

References

3 Persons not related to you who you have known for at least one year

Reference Name

Phone

Business

Years Aquainted

Reference Name

Phone

Business

Years Aquainted

Reference Name

Phone

Business

Years Aquainted

Emergency Contact

Emergency Contact Name

Phone

Address

Street Address City State ZIP Code

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, sexual orientation, marital or veteran status, or any other legally protected status. All employees will be registered with the Family Care Safety Registry and the State of Missouri Department of Health and Senior Services.

Consent

Submission of this form indicates agreement with the following statements:*

I certify that answers given herein are true and complete.
I agree that employment with Angels on Duty Inc. is dependent upon the completion of a drug screening and background test.
I authorize investigation of all statements contained in the application for employment as may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
In the event of employment, I understand that false or misleading information given in my application or interview's may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

I have read and agree to the above statements.

Phone

This field is for validation purposes and should be left unchanged.

Join Our Team of Angels

Employment Application

Applicant Information

Position Information

Education

Former Employers

Employer #1

Employee #2

Employee #3

Former Employers (cont)

Employee #4

Employee #5

References

Emergency Contact

Consent

Learn how our angels can help you!

Call us at 636.980.HALO (4256) or 636.294.WING (9464)

Or, submit this form and we'll reach out to you!

Are we a good fit?

Company Info