Application For Employment

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Application For Employment

First Name*

Last Name*

Email*

Phone *

Ext

Work
Mobile
Home

Address Line 1*

Address Line 2

City*

State/Province*

Postal Code*

Country *

How did you learn about us

Referred by

If you are under 18 years of age, can you provide proof of your eligibility to work?

Have you ever filed an application with us before?

Have you ever been employed with us before? (If Yes, give date)

If Yes, give date

Have you ever been employed with us before?

If Yes, give date

Are you available to work

What shifts are you willing to work?

What position are you applying to?*

On what date would you be available to work?

Are you currently employed?

Are you currently on "lay-off" status and subject to recall?

Are you prevented from lawfully becoming employed in this country because of VISA or Immigration Status?

Have you ever been convicted of any criminal violation of law, or are you now under pending investigation or charges of violation of criminal law ?

Have you ever been convicted of or ajudicated as a juvenile for a crime against a person?

Have you been the subject of any adverse action(s) by any duly authorized sanctioning or disciplinary agency for either conduct based or performance based actions?
If ye, please explain:

Have you ever been disciplined or terminated for accessing or using protected health information without employer authorization?

Have you ever been debarred, excluded or otherwise ineligible from participation in a Federal or State health care program?

Have you ever been excluded or debarred from any Federal health care program or defaulted on a health education loan or scholarship?

List all names you have been known by:

Has an agency ever imposed sanctions against your license?

Education

High School Name

High School Address

Course of Study

Years Completed

Diploma Degree

Undergraduate College Name

Undergraduate College Address

Course of Study

Years Completed

Diploma Degree

School Name

School Address

Years Completed

Diploma Degree

Other (Specify)

Additional Information

Employer*

Employer Address*

Telephone No.*

Job Title*

Supervisor*

Reason for Leaving*

Dates Employed (from - to)*

Hourly Rate/Salary (starting - final)*

Work Performed*

Employer

Employer Address

Telephone Number

Job Title

Reason for leaving

Dates Employed (from - to)

Hourly Rate/Salary (starting - final)

Work Performed

Employer

Address

Telephone Number

Job Title

Reason for leaving

Dates Employed (from - to)

Hourly Rate/Salary (starting - final)

PERSON TO BE NOTIFIED IN CASE OF EMERGENCY:

Name

Phone*

Relationship

Address

Professional References (required and cannot be relation)

Reference's Contact Information

Professional References (required and cannot be relation)

Reference's Contact Information

Read and Sign Waiver

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. As condition for employment, we will conduct a drug test, a criminal background check, and review the history of any work related injuries.

This application for employment shall be considered active for a period of time not to exceed 365 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

I, the undersigned, hereby authorize the release of information related to my employment. I will save Sunshine Meadows Retirement Community, any previous employer or their employees, harmless from the exchange of such information. I further relinquish any and all rights or claims to proceedings of any nature related to the exchange and consideration of such information.

I am over 18 or the legal guardian of the participant above and I accept the terms of the waiver.

Your birthdate

IP: 44.200.94.150
Oct. 14, 2024

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Application For Employment

Contact Info

Additional Information for Your Application(s)

1 X Application

Read and Sign Waiver