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Menu
Care Types
Independent Living
Assisted Living
Memory Care
Amenities
About Us
About Us
Services
Contact Us
Healthcare Tidbits
Pay Online
520-458-0100
Schedule Tour
Care Types
Independent Living
Assisted Living
Memory Care
Amenities
About Us
About Us
Services
Contact Us
Healthcare Tidbits
Pay Online
Menu
Care Types
Independent Living
Assisted Living
Memory Care
Amenities
About Us
About Us
Services
Contact Us
Healthcare Tidbits
Pay Online
Employment
Employer
Position Applying For
Enter your Name
Enter your Name
First
First
Last
Last
Street Address
City
State
Zip
Home Telephone No.
Business Telephone No.
Cellular Telephone No.
Date you can start work
Salary Desired
Do you have a High School Diploma or GED?
Yes
No
Position Information
Full Time
Part Time
Status
Regular
Temporary
Select Below:
Swing
Graveyard
Weekends
Select Below:
Days
Evenings
Are you authorized to work in the U.S. on an unrestricted basis?
Yes
No
Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment.) Yes No If yes, explain:
Yes
No
Text
If yes, explain:
Have you been told the essential functions of the job or have you been viewed a copy of the job description listing the essential functions of the job?
Yes
No
Can you perform these essential functions of the job with or without reasonable accommodation?
Yes
No
Enter your Qualifications
Enter your Qualifications
School
School
Degree
Degree
Address/State/City
Address/State/City
School
School
Degree
Degree
Address/State/City
Address/State/City
Special Skills
List any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc.
REFERENCES
Please list three professional references not related to you, with full name, address, phone number, and relationship. If you don’t have three professional references, then list personal, unrelated references.
Name
Enter First Reference
Address
Phone
Relationship
Name
Enter Second Reference
Address
Phone
Relationship
Name
Enter Third Reference
Address
Phone
Relationship
WORK HISTORY
Start with your present or most recent employment and work back. Use separate sheet if necessary. (INCLUDE PAID AND UNPAID POSITIONS)
Start Date
Job Title 1
End Date
Job Title 1
Company Name
Job Title 1
Supervisor’s Name
Phone Number
City
State
Zip
Position
Reason for Leaving
Starting Salary
Ending Salary
May we contact your present employer?
Yes
No
N/A
Start Date
Job Title 2
End Date
Job Title 2
Company Name
Job Title 2
Supervisor’s Name
Phone Number
City
State
Zip
Position
Reason for Leaving
Starting Salary
Ending Salary
I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge.
I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application. I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.
Signature
Date
If you are human, leave this field blank.
Submit