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The Crumley House

“Enhancing the quality of life for survivors of brain injury by enabling them to maximize their potential.”

Employment Application – Complete Online

The Crumley House Brain Injury Rehabilitation center is committed to the provision of equal employment opportunities to its applicants regardless of race, color, sex, age, religion, national origin, disability, veteran status or any other characteristics as protected by law.  This application is intended to allow you to provide our organization with information to evaluate your suitability for the position(s) for which you are applying.

Please note, if you desire to download, print and mail your application as opposed to completing online, please click here.

Employment Application

This is an application for employment at The Crumley House.

"*" indicates required fields

Step 1 of 9

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Address
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Shift Desired

Education History

This is to provide us with information concerning your previous educational experiences:
High School Address:
Year Graduated and Degree/Diploma if obtained
College/University Address:
Year Graduated and Degree if obtained
College/University Address:
Year Graduated and Degree/Certificate/Diploma if obtained

Employment History

Proceed with listing employment in reverse chronological order, that is the most recent employment first.
Employer's Address:
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May place today's date if employment is ongoing.
Employer 2 Address:
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May place today's date if employment is ongoing.
Employer 3 Address:
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May place today's date if employment is ongoing.

Volunteer Work

Please list any Volunteer work you have done in the past 12 months.

References

Please make sure that two people are not related to you.
Reference 1
Address of Reference 1
Name of Reference 2
Address of Reference 2
Name of Reference 3
Address of Reference 3

Professional Certification

List of Certificate
Certificate
State
ID Number
Expiration Date
 
List of the Certificates that you have, the plus sign will allow you to add additional values if needed.
Other states where formerly or currently registered.
License suspended or revoked?*

Is your professional license currently suspended or revoked in any state?

Have you ever been convicted, forfeited bond, or are you currently on probation for any felony (or any equal offense under military law)? (A felony is defined as an offense punishable by imprisonment for a term of one year or greater.)

Answer required*
Explain the date, charge, place and action taken.

Accuracy

The information provided on this application is accurate to the best of my knowledge and subject to verification by this company . I understand I must truthfully answer all the questions on this application. I also understand that if I do not, I may be refused employment, or separated if I am a current company employee. I understand that my employment is not covered by an employment contract and that my employment can be terminated at any time by either party. I also understand that I will have a 90 day probationary period with the Crumley House.

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The Crumley House

300 Urbana Rd
Limestone, TN 37681
Phone: (423)257-3644
Fax: (423)257-6594
501 (c)(3) non-profit organization
©2013-

  • Guynn Edwards, Executive Director
  • Clay Morelock, Program Director
  • Fredda Roberts, TBI Coordinator
  • Staff
  • Employment Application – Complete Online
  • Employment Application – Download, Print & Mail
  • Background Authorization Form – Complete Online
  • East Tennessee Foundation
  • Tax Return
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