Personal Information

Academic Institution & Advisor Information

Department Chair/Advisor Information

Learning Goals & Experience

Language Proficiency

Program Requirements & Compliance

As a provider of services for the Missouri Department of Mental Health and a licensed Child Care provider by the Missouri Department of Health and Senior Services all employees must meet eligibility requirement of these two entities. An applicant is ineligible for hire if applicant:

I certify that all the statements made in this application are true, correct, and complete to the best of my knowledge and are made in good faith. I understand that any misinformation may be the cause for disqualification or termination of employment.

If this application for employment is accepted, I understand and agree that the terms, conditions, compensation, benefits, hours, schedule, and duration of my employment may be determined, changed, and modified from time to time at the will of my Employer without limitation or condition.

I hereby authorize Lafayette House to request a criminal record review with the Missouri Highway Patrol.

I hereby authorize any person, corporation, or other organization listed above to furnish any information regarding me, as is necessary to determine my eligibility for employment. I hereby release such person, corporation, or other organization from any and all liability for releasing such information, if information is provided in good faith, with no malice intended. I further agree to abide by all rules and policies of Lafayette House.

I hereby acknowledge that I understand that Lafayette House participates in the United States Department of Homeland Security E-Verify program. The E-Verify program is an internet-based eligibility verification system operated by the U.S. Citizenship and Immigration Services. I understand that if I am hired, I must be able to prove my identity and my eligibility to work in the United States using forms of documentation deemed acceptable by the Bureau of Citizenship and Immigration Services. I acknowledge that failure to do so may constitute grounds for termination or an offer of employment rescinded.