Job Application Please enable JavaScript in your browser to complete this form.1Personal Details2Employment Background3Additional Questions4References5SubmitYour Name *FirstMiddleLastToday's Date *Current Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeYour Email *Your Phone *Other PhoneReferred ByEmployment DetailsPosition Applied For: *Location: *Wesley CourtThe CraigThe ParksMeadow LakeEvergreen Support Office - AbileneDate Available *Type of employment desired: *Full-timePart-timeTemporaryOn-callTimes and Days of the Week available for work: *Salary Desired: *Are you legally eligible for employment in this country? *YesNoAre you available to work overtime if required? *YesNoAre you available to work weekends if required? *YesNoHave you been employed at this company before? *YesNoIf yes, when?Are you related to anyone who currently works at any of our communities? *YesNoTo comply with the Immigration Reform and Control Act of 1986, if you are hired you will be required to provide documents to establish your identity and your authorization to be employed in the United States. Such documents will be required within the first three business days following your hire, or upon your first work day if your employment period will be less than three days.If yes, who?Please list nameHave you ever been convicted of a crime? *YesNoIf yes, please explain.Have you ever been placed on probation? *YesNoAre you now, or have you ever been, investigated by any law enforcement or federal, state or local regulatory agency? *YesNoIf yes, please explain.NextPlease specify your complete full-time and part-time employment history, including self-employment. Begin with your most recent employer.Employer 1Employer: *Phone: *Address: *Employed from: *Employed until: *Starting Salary: *Starting $/per hr, yrEnding Salary: *Final $/per hr, yrImmediate supervisor and title: *Reason for Leaving: *Your job title: *Summarize the type of work performed and job responsibilities: *May we contact for reference? *YesNoLaterEmployer 2Employer:Phone:Address:Employed from:Employed until:Starting Salary:Starting $/per hr, yrEnding Salary:Final $/per hr, yrImmediate supervisor and title:Reason for Leaving:Your job title:Summarize the type of work performed and job responsibilities:May we contact for reference?YesNoLaterEmployer 3Employer:Phone:Address:Employed from:Employed until:Starting Salary:Starting $/per hr, yrEnding Salary:Final $/per hr, yrImmediate supervisor and titleReason for Leaving:Your job title:Summarize the type of work performed and job responsibilities:May we contact for reference?YesNoLaterEmployer 4Employer:Phone:Address:Employed from:Employed until:Starting Salary:Starting $/per hr, yrEnding Salary:Final $/per hr, yrImmediate supervisor and title:Reason for Leaving:Your job title:Summarize the type of work performed and job responsibilities:May we contact for reference?YesNoLaterBackNextWhat was the best job you've ever had? Why did you like it so much? *What was your least favorite job? What did you NOT like about it? *Who was the best supervisor or manager you've had? What characteristics made that person a good manager? *Think of the WORST supervisor or manager you've had. What characteristics made that person a POOR manager? *What are your greatest strengths? *As your skills and abilities relate to your work experiences, what are the areas for improvement? *What traits or characteristics do you most admire in co-workers? *What traits or characteristics do you most DISLIKE in co-workers? *What do you think is the most difficult part of customer service work? *BackNextReferencesList the names, relationship, number of years acquainted and phone number of 3 references (No relatives please)Name *Relationship / Years Acquainted *Phone *Name *Relationship / Years Acquainted *Phone *Name *Relationship / Years Acquainted *Phone *BackNextI certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (I) cancel further consideration of this application, or (ii) immediately discharge me from the employer’s service, whenever it is discovered. I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law. I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application. If I am hired, I understand that I am free to resign at any time, with or without cause, and the employer reserves the same right to terminate my employment at any time, with or without cause, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president. I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal Immigration laws require me to complete an I-9 Form in this regard.I have read and understand the above disclosure *YesApplicant Signature *Please type your nameToday's Date *PhoneSubmit
