APPLICATION


	APPLICATION


	Application for Employment


	We consider applicants for all positions without regard to race, color creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.

Click NEXT button to see a list of 3701-13-05 Disqualifying offenses.

Don't forget to submit a REFERENCE CHECK FORM for each former/ current employer that you give us permission to talk to.

**CAUTION** Moving between pages ERASES all information that has been entered!!! Look at Disqualifying offenses ^^BEFORE^^ filling out application.


	* MUST be filled in to submit form


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	Name:


	Address:


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	City:


	State/Prov:


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	County:


	Zip/Post. code:


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	*


	Phone:


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	E-mail:


	Social Security Number (optional)

Position (s) Applied For:

Front Office

Laundry

Social Services

Janitorial

Dietary

Maintenance

Nursing

All / Any

Housekeeping

How did you hear about us?

Friend

Employment Agency

Relative

Inquiry

Other:


	*


	Best time to contact you at home is:


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

Yes


	If Yes, Give Date


	Have you ever filed an application with us before?

Yes


	Have you ever been employed with us before?


	If Yes, Give Date

Yes


	If Yes, Who


	Do any of your friends, or family work here?

Yes


	Are you currently employed?

Yes


	May we contact your employer?

Yes


	Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status? Proof of citizenship or immigration status will be required upon employment

Yes


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

Yes


	Your available to work

Full Time


	Date available to work


	*

Part Time


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	What is your desired salary range?

Temporary


	1st shift = approx 8-4pm 2nd shift = approx 4pm-Midnight 3rd shift = approx Midnight--8am Times are approximate, different departments have different shift times.

1st Shift


	Your available to work

2nd Shift

3rd Shift


	EDUCATION


	Name & Address


	Course of Study


	Years Com


	Grad ?


	SCHOOL


	High School


	College


	Graduate


	Other


	WORK EXPERIENCE


	Employer 1


	Dates Employed


	Work Performed


	Address


	From


	To


	Phone Number


	Job Title


	Hourly Wage


	Supervisor


	Start


	Final

Yes we may contact


	Reason For Leaving

No we may not contact


	Employer 2


	Dates Employed


	Work Performed


	Address


	From


	To


	Phone Number


	Job Title


	Hourly Wage


	Supervisor


	Start


	Final

Yes we may contact


	Reason For Leaving

No we may not contact


	Employer 3


	Dates Employed


	Work Performed


	Address


	From


	To


	Phone Number


	Job Title


	Hourly Wage


	Supervisor


	Start


	Final

Yes we may contact


	Reason For Leaving

No we may not contact


	Describe any specialized training, apprenticeship, skills and extra-curricular activities


	Describe any job-related training received in the United States Military


	List professional, trade, business or civic activities and offices held


	ADDITIONAL INFORMATION

Spreadsheet

Terminal


	SPECIALIZED SKILLS

PC / MAC

Word Processing

Typewriter

Shorthand


	WPM


	WPM


	State any additional information you feel may be helpful to us in considering your application.


	PERSONAL / PROFESSIONAL REFERENCES. Do NOT include family members or past supervisors.


	*


	Name 1


	*


	Phone Number


	Best Time to Call


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	Occupation


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	PERSONAL / PROFESSIONAL REFERENCES. Do NOT include family members or past supervisors.