Application Step 1 of 6 16% Name* First Middle Last How did you hear about us?RadioTVSocial MediaFriend/FamilySearch EngineOtherOther Source Your PhoneYour Email* Your Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Which position are you applying for?Housekeeping LaundryCertified Nurse AideDietary WorkerUniversal WorkerAvailability Days Evenings Overnights Capacity Part-time Full-time Temporary/PRN Have you ever filed an application with us before? No Yes Yes, Dates Have you ever been employed with us before? No Yes Yes, Dates Can you travel if a job requires it? No Yes May we contact your current employer? No Yes Have you ever had any job related training in the United States Military? No Yes Yes, Explain Are you capable of performing the essential functions of this position? No Yes Indicate any foreign languages you can speak, read and/or write. References (Cannot be related to you or a previous employer.)Reference - 1Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneReference - 2Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneReference - 3Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone Education: High SchoolName Location Diploma/Degree Training/Honors/Etc. Check all years completed. 8 9 10 11 12 Education: Trade SchoolName Location Diploma/Degree Training/Honors/Etc. Check all years completed. 1 2 3 4 Education: College/UniversityName Diploma/Degree Training/Honors/Etc. Check all years completed. 1 2 3 4 Education: Additional SchoolingName Location Diploma/Degree Training/Honors/Etc. Check all years completed. 1 2 3 4 Employment ExperienceStart with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, handicap or other protected status.Employment - 1Employer Name Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneJob Title Supervisor Reason for Leaving Date Began MM slash DD slash YYYY Date Ended MM slash DD slash YYYY Starting Rate Final Rate Work Performed/Responsibilities:Employment - 2Employer Name Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneJob Title Supervisor Reason for Leaving Date Began MM slash DD slash YYYY Date Ended MM slash DD slash YYYY Starting Rate Final Rate Work Performed/Responsibilities:Employment - 3Employer Name Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneJob Title Supervisor Reason for Leaving Date Began MM slash DD slash YYYY Date Ended MM slash DD slash YYYY Starting Rate Final Rate Work Performed/Responsibilities: Special Skills and QualificationsSummarize special job-related skills and qualifications acquired from employment or other experiences.If you were unemployed at any time since leaving school, please indicate what you were doing during this time.Upload ResumeAccepted file types: pdf, doc, docx, jpg, jpeg, Max. file size: 2 MB.Acceptable File Formats: pdf, doc, docx, jpg, jpegApplicant's Statement & AgreementI certify that the answers given in this Application for Employment are true and complete to the best of my knowledge. The facility may investigate all statements made in this Application. The facility is required by law to check for any criminal or abuse record. I understand that any false or misleading information provided can result in a decision not to hire, immediate discharge if hired, and civil or criminal penalties in appropriate cases. In signing this Application I state that I have received a copy of the Job Description for all jobs for which I have applied. I understand that I will be required to fulfill all aspects of any job if I am hired to perform the job. I understand that the failure to fulfill any aspect of the job may result in termination. I also understand that I may be required to take a physical examination conducted by a physician of the employer’s choosing after I am given a qualified offer of employment and that a health screening for diseases such as TB is required. I understand that this Application is not a contract of employment; that if hired, regardless of any oral representations to the contrary, the employment relationship between myself and the facility is terminable at will; that I have the right to terminate my employment at any time for any reason, and the facility retains the same right. Any changes to this employment relationship must be in writing. I understand that if hired I am required to abide by all rules and regulations of the facility. If hired, you will be required to submit documents sufficient to establish employment authorization and identity compliance with the Immigration Reform and Control Act of 1986. While you need not provide this proof of citizenship or immigration status at the time you are interviewed, please be prepared to assure us that you can do so immediately upon being hired. AN EQUAL OPPORTUNITY EMPLOYER This facility is an equal opportunity employer. Employment decisions are made without regard to age, race, color, sex, sexual orientation, gender identity, national origin, religion, disability, status as a disable Vietnam era veteran, or other category as specified by law.
Resident of the Month Posted on August 16, 2018 by IMT-Webmaster Congratulations to the August Resident of the Month, Mr. Robert Bunn! Read More
Employee of the Month Posted on August 16, 2018 by IMT-Webmaster Congratulations to Elizabeth Otten on being named the Clarence Senior Living August Employee of the Month! Read More