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Who We Are
Board of Directors
Our Team
Careers/Employment
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Get Involved
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Employment Application
THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT
but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a pre-employment drug screening and/or medical examination. This application will remain active for 3 years.
Job Posting
Select Posting to Apply for
Select Posting to Apply for
- Select Posting to Apply for -
Submit Application - not a specific job
Personal Information
First Name
Middle Name
Last Name
Home Phone
Work Phone
Cell Phone
Email Address
Addresses
Current Address 1
Street
Street
City
City
State
State
Zip Code
Zip Code
Since (Mo/Yr)
Since (Mo/Yr)
To (Mo/Yr)
Prior Address
Street
City
State
Zip Code
Since (Mo/Yr)
To (Mo/Yr)
Prior Address
Street
City
State
Zip Code
Since (Mo/Yr)
To (Mo/Yr)
Education
School Attended
City
State
Diploma
Degree/Cert.
Area of Study
High School
High School
School Attended
City
State
Diploma
No
Yes
GED
Undergrad School
Undergrad School
School Attended
City
State
Diploma
No
Yes
Degree/Cert.
Area of Study
Grad School
Grad School
School Attended
City
State
Diploma
No
Yes
Degree/Cert.
Area of Study
Other School
Other School
School Attended
City
State
Diploma
No
Yes
Degree/Cert.
Area of Study
Employment Information
Position Applied For
Date You Can Start (yyy-mm-dd)
Desired Salary $
Do You Prefer
Full-Time
Part-Time
Either
Can you work
Weekends
Evenings
Available
M
Tu
W
Th
F
Sa
Su
Are you available for shift work?
No
Yes
Please answer all of the following questions.
1.
Are you able to comfortably ascend and descend stairs?
No
Yes
Are you able to assist with lifting and transferring individuals as needed
No
Yes
2.
Are you able to respect each person’s personal choices regarding lifestyle (ex. Smoking)
No
Yes
3.
We support people who may need assistance with toileting and personal hygiene. Would you be comfortable assisting with these tasks?
No
Yes
4.
Have you ever been discharged or asked to resign from a job?
No
Yes
If yes, please explain...
5.
Have you ever been convicted of or pled guilty to a felony or crime other than a minor traffic citation?
No
Yes
If yes, please explain...
6.
Do any of your friends or relatives, other than spouse, work here?
No
Yes
If yes, state name and relationship...
Employment History
Are you currently employed?
No
Yes
May we contact your present employer?
No
Yes
Most Recent Employer
Employer
Employer
City
City
State
State
Zip Code
Zip Code
Phone
Phone
Position Held
Position Held
From (m/yyyy)
From (m/yyyy)
To (m/yyyy)
To (m/yyyy)
Pay upon leaving
Pay upon leaving
Supervisor
Supervisor
Duties
Duties
Reason for Leaving
Reason for Leaving
Prior Employer 1
City
State
Zip Code
Phone
Position Held
From (m/yyyy)
To (m/yyyy)
Pay upon leaving
Supervisor
Duties
Reason for Leaving
Prior Employer 2
City
State
Zip Code
Phone
Position Held
From (m/yyyy)
To (m/yyyy)
Pay upon leaving
Supervisor
Duties
Reason for Leaving
Prior Employer 3
City
State
Zip Code
Phone
Position Held
From (m/yyyy)
To (m/yyyy)
Pay upon leaving
Supervisor
Duties
Reason for Leaving
Job-related Skills
Please answer the following questions if the position you are applying for requires driving a motor vehicle
1.
Do you have a valid driver's license?
No
Yes
If yes, Driver's License Number
Date of Issue
2.
Have you been convicted of or pled guilty to any traffic-related offense within the past five years?
No
Yes
If yes, please explain...
3.
Have you had your driver's license suspended or revoked or had your driving privileges modified by a court of law?
No
Yes
If yes, please explain...
4.
Please list all states from which you hold or held a driver's license
5.
Please use this space to list any special skills you may have that relate to the position applied for
6.
Please list any professional licenses, designations, certifications, etc. that may relate to the position applied for. Include date granted, name of organization, and any other relevant information.
References
Reference 1
Name
Name
Address
Address
Telephone
Telephone
Relationship
Relationship
Years Acquainted
Years Acquainted
Reference 2
Name
Address
Telephone
Relationship
Years Acquainted
Reference 3
Name
Address
Telephone
Relationship
Years Acquainted
Reference 4
Name
Address
Telephone
Relationship
Years Acquainted
Resume (Text Version)
Copy and Paste a text version of your resume here.
Upload File
Attach a file to your application submission
(Permitted File Types: doc,docx,pdf,txt - Max file size: 1045876 bytes)
Applicant Certification Agreement
1.
The company and other persons or employers are released from all liability brought forth by any investigation resulting from my submission of this electronic application and the data contained here in.
2.
The information in this application is true and complete to the best of my knowledge. Any falsification, misrepresentation, or omission on this application can be cause for denial or termination of employment.
3.
If hired, my employment is voluntary, meaning that either party can employment at any time for any reason. Upon acceptance of employment if a position is offered, I agree to abide by all existing and future company rules and regulations. The company reserves the right to change any working agreement as deemed necessary.
4.
Any employment offer is contingent open my providing proof of identity and eligibility to work the country of employ.
5.
I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully.
6.
I understand that by typing my name in the signature box below and submitting this application electronically, this becomes a legal and binding contract.
Security Code
Type Name in Signature Box:
Date:
2024-04-26 10:43:04
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