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This application form was designed for use by persons applying for various types of positions - clerical, professional, technical, and administrative. Please answer these questions to the best of your ability. You may answer “Not applicable”. This application will be considered active for only 90 calendar days. If you are not contacted for an interview or employed during this period, it will be necessary for you to reapply in writing or in person for future consideration.
In the following spaces, give a complete record of your employment. Begin with your most recent employment and work back. Use a separate sheet to list additional employers if you have had more than 3 former employers. Please note if we cannot contact a certain employer.
I hereby affirm that the information provided on this application form (and accompanying resume, if any) is true and complete to the best of my knowledge and agree to advise the Director of this property in writing, of any change or addition to any information contained in this application. I agree that false information or the omission of information from this Application (including leaving blanks on this Application or my failure to correct or add to the information changes during the course of my employment) (“Inaccurate Information”) may disqualify me from consideration for employment or continued employment and may result in my immediate dismissal if discovered at a later date. I further agree to hold harmless and indemnify the property (“Company”) from any and all liability that may be caused by the Company relying on Inaccurate Information.
I authorize the investigation of my past employment and other qualifications of employment as deemed appropriate and agree to cooperate in such investigation. I agree to release, indemnify and hold harmless all persons and other entities (third parties) providing the information requested by the Company. I also agree to release, indemnify and hold harmless the Company from any and all liability in connection with its conducting such investigation as it deems appropriate and the use of the information received from Third Parties.
I further agree to promptly advise the Director of this property in writing, of any mental or physical condition, illness or contagious disease or condition that may cause me to present a risk of harm to the residents or staff of the property.
I consent to submit to such examinations and other health assessments requested by the Company to determine my continuing qualifications to perform the essential responsibilities of any position I may have to be considered for by the Company. I also agree to the release of copies of all health information requested by the Company which is or may be related to my qualifications to work.
I understand that if I am hired, my employment with the Company may be terminated, with or without cause, at any time at the discretion of either Company or myself. I understand that, if I am accepted for employment with the Company, the Company reserves the right to change my job responsibilities, wages, benefits and any other term of or condition of my employment with the Company at any time to meet the needs of the Company.
I understand and agree that, at the time that my voluntary or involuntary termination from employment with the Company, I am entitled to the wages I earned as of the last day I worked for the Company. I hereby agree that any amounts I owe to the Company at that time may be set off and applied against the wages owed to me at the time of termination.
I further understand that this is an application for employment and that no employment is being offered by this application.