Assisted Living at Its Finest
Please complete the application below and submit. Upon receiving the application, the administrator will review it and contact you. If you have any questions, please contact us. Thank you.
We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other
status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors.
Answer each question fully and accurately. No action can be taken on this application until you have answered
all questions. Use the space for ‘Additional Information’ on page 8 of this form if you do not have enough room
on this application. In reading and answering the following questions, be aware that none of the questions are
intended to imply illegal preferences or discrimination based upon non-job-related information.
List name and address of schools
What skills or additional training do you have that relate to the job for which you are applying?
What machines or equipment can you operate that relate to the job for which you are applying?
List names of employers in consecutive order with present or last employer listed first. Account for all periods
of time including military service and any periods of unemployment. if self-employed, give firm name and
supply business references.
Note: A job offer may be contingent upon acceptable references from current and former employers.High
If YES, whom do you suggest we contact?
Give three references, not relatives or former employers
Please read each statement carefully before signing
I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.
I authorize the investigation of any or all statements contained in this application. I also authorize, whether
listed or not, any person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.
I understand I may be required to successfully pass a drug screening examination. I hereby consent to a preand/
or post-employment drug screen as a condition of employment, if required.
I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as
may be deemed necessary to judge my capability to do the work for which I am applying.
I understand that this application, verbal statements by management, or subsequent employment does not create an express or implied contract of employment nor guarantee employment for any definite period of time. Only the president of the organization has the authority to enter into an agreement of employment for any specified period and such agreement must be in writing, signed by the president and the employee. If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time, with or without reason and with or without notice.
I have read, understand, and by my signature consent to these statements.
This application for employment will remain active for a limited time. Ask the organization’s
representative for details.