Applications are available at the main office.Located at 425 5th Ave NW Attalla, AL 35954 For inquiries regarding employment and employment verifications, Click Me!Application For Employment Position(s) Applied ForDate Name First Last PhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Personal References (No Relatives or Former Employees)Name First Last PhoneEmail Name First Last PhoneEmail Have You Ever Worked for This Organization?YesNoMilitary Service?YesNoDate Entered: Date Discharged: Can You Provide Proof That You Are Eligible To Work In The United States?YesNoAre You Available To Work:Full TimePart TimeShift WorkOver-TimeAre You on Lay-off and Subject to Recall?YesNoCan You Travel If The Job Requires It?YesNoHave You Ever Been Convicted Of A Felony?YesNo(Conviction does not automatically disqualify applicant)If Yes, Give Full ExplanationDo You Have a Valid Driver's License?YesNoLicense NumberEducationPhysician License NumberMedicare/Medicaid NumberOther State License NumbersPsychologist, MSW, Counselor, Nurse, LPN, Pharmacist License NumberState State / Province / Region Eligible For License High SchoolYear CompletedGraduatedYesNoCollege Or UniversityYear CompletedGraduatedYesNoWhat Was Your Major Field Of Study?Employment History (Last three employers)Employer 1 Company Name Job Title Years Employed Phone Number Supervisor Employer 2 Company Name Job Title Years Employed Phone Number Supervisor Employer 3 Company Name Job Title Years Employed Phone Number Supervisor Are You Presently Employed?YesNoMay we Contact Present Employer?YesNoWhen Could You Begin Work? Terms: UNDERSTAND AND AGREE by Submitting1. The information given in this application is given of my own free will and accord and is true and correct to the best of my knowledge and belief. I understand that my responses to all questions on this application and during the entire application process are being relied upon by CED Mental Health in making its hiring decision. Any material misrepresentation or deliberate omission of requested information in my application may be justification for refusal of, or if employed, termination from employment. 2. An incomplete application will not be considered. 3. This is my express permission for CED Mental Health to contact prior employers to obtain any and all information related to my past work performance. It is my understanding that CED Mental Health will make a thorough investigation of my work and personal history and may verify all data given in my application for employment, related papers or oral interviews. 4. My employment may be terminated by CED Mental Health at any time without liability for wages or salary except such as may have been earned at the date of such termination. 5. Although management makes every effort to accommodate individual preferences, business needs may at times make the following conditions mandatory: overtime, shift work, a rotating work schedule or a work schedule other than Monday through Friday. 6. I understand that if offered employment, my employment may be contingent upon the results of a physical examination at the request of CED Mental Health. I consent to such an examination and to the release of the information from the examination to CED Mental Health. I also consent to submit to periodic physical examinations or blood tests as an employee of CED Mental Health. 7. All job applicants of CED Mental Health undergo testing for the presence of illegal drugs as a condition of employment. Any applicant with a confirmed positive test result will be denied employment. CED Mental Health will not discriminate against applicants for employment because of a past history of drug abuse. Therefore, individuals who have failed a re-employment test may initiate another inquiry with CED Mental Health after a period of no less than six months, but must present themselves drug-free. I further understand that this is an application for employment and that no employment contract is being offered. I understand that if I am employed, such employment is for an indefinite period of time and that CED Mental Health can change wages, benefits and conditions at any time. ResumeAccepted file types: pdf, doc, docx.CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms.