Job Application

Complete the application below.
(Examples: Driver’s license, Social Security Card, Birth Certificate, and/ or Immigration Documentation)


Licenses/ Certifications

Employment History

List all employment beginning with the most recent and work back.


Professional References

(Do not include former employers or relatives.)

I understand that misrepresentation or omission of facts in this application is sufficient cause for dismissal/ denial of employment. I understand that nothing in this application or granting of an interview is intended to create an employment contract between SHCMHC and myself.

I authorize the use of any information in this application to verify my statements, and I authorize past employers, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damages on account of having furnished such information.

I understand that this application will be kept on active file for 60 days from the date completed, after which time I would have to reapply in accordance with established company procedures

West Virginia is an employment-at-will state meaning that either the employer or the employee can terminate the relationship at any time for any reason.

Title VI Notice: Southern Highlands Community Mental Health Center operates its programs and services without regard to race, color, and national origin in accordance with Title VI of the 1964 Civil Rights Act. To find out more about our nondiscrimination obligations, to file a complaint, or to request this information in another language please contact us at (304)425-9541.
Your Rights Regarding Your Protected Health Information
Skip to content