Employment Wayside Employment Application What position are you applying to?(Required)Full Legal Name(Required) First Last Preferred Name(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Phone Number(Required)Your Email Address(Required) Enter Email Confirm Email What is your availability for a call or interview?(Required)If we were to offer you a position, when would you be able to start work?(Required)What shifts are you looking for? Select all that apply.(Required) Full time Part time On call Evenings Overnights Weekends Are you authorized to work in the United States? (Proof of identity and eligibility will be required upon employment.)(Required) Yes No Are you willing to under go a background check with the MN Department of Health and Human Services?(Required) Yes No Are you 18 years of age or older?(Required) Yes No Have you ever been employed by The Wayside House Inc (DBA Wayside Recovery Center)? If yes, please list dates and job title(s).(Required)Do you have friends or relatives that work for Wayside Recovery? If yes, who and what site do they work at?(Required)How did you find out about Wayside Recovery?(Required)Please list your education history, including school names, years, and highest degree obtained.(Required)Your Previous Employers(Required)Please list your employment history with your most current position, company name, months and years below.EmployerDatesPosition Add RemoveUpload Your Resume(Required)Upload your resume in .pdf, .doc or .docx formatAccepted file types: pdf, doc, docx, Max. file size: 25 MB. Please list your active state board license or certifications.(Required)If you are applying for a MH or NP position that requires credentialing, have you been credentialed with the MN payors in the past?(Required)Upload a copy of your active state board license or certifications.Accepted file types: pdf, doc, docx, Max. file size: 25 MB. Please list any special skills related to the position you are applying for.(Required)Please upload a cover letter and tell us more about your experience and why you would be a good fit for this position and why you are interested in working for Wayside Recovery.(Required)Accepted file types: pdf, doc, docx, Max. file size: 25 MB. Are you able to perform the essential functions of this job with or without a reasonable accommodation? If you require reasonable accommodation to complete a job application, pre-employment testing, or a job interview, please contact HR@Waysiderc.org.(Required) Yes No Sign and SubmitSignature(Required)I certify that all statements made on this application are true, complete, and correct to the best of my knowledge and belief. I understand my statements are subject to verification. I also understand that falsification on this application will disqualify me from employment or result in dismissal. Please type your name in the box below to sign.Today's Date(Required) MM slash DD slash YYYY
