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Employment Application
First name
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Last name
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Home address
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City
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State/Region
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Postal Code
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Phone number (xxx-xxx-xxxx)
Date of birth (xx/xx/xxxx)
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Email
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Position applied for
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Please Select
Lead Caregiver
Caregiver
Lead Caregiver
Resident Chef
Groundskeeper & Maintenance
Volunteer
Date available to start
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Year
/
Month
/
Day
How did you hear about us?
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Please Select
Newspaper
Google
Bing
Yahoo
Facebook
Indeed
Zip Recruiter
Personal Referral
If referred, who by?
Employment Preference
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Full-time
Part-time
Temporary
On call
Schedule Preference
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Day Shift - (7am - 7pm)
Night Shift (7pm - 7am)
On Call
Are you able to work 12 hours shifts?
Please Select
Yes
No
Days available to work
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Are you available to work holidays?
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Please Select
Yes
No
Please describe any commitments or outside responsibilities which would require your absence from work:
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Have you ever worked for this company before? If yes, when?
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Do you have any relatives or close friends that have ever worked for New Hope Senior Living? If so, please list their names.
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Is there any type of work which your physical condition prohibits, or have you ever been advised by a doctor not to perform certain types of work? If yes, please explain:
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Have you ever been convicted of a criminal offense involving the abuse or intentional neglect of an elderly or vulnerable individual If yes, please explain.
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Have you ever been convicted of any crime greater than a traffic violation? If yes, please explain.
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Are you authorized to work in the United States?
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Yes
No
Do you have a valid state-issued drivers license?
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Yes
No
License / ID #
State Issued
Record of Employment
Are you currently employed?
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Please Select
Yes
No
Most Current Employer
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Employers Address
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Employers City
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Rate of Pay
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Employers Phone Number (xxx-xxx-xxxx)
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Reason For Leaving
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List of jobs you held, duties performed, skills used or learned, advancements or promotions.
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May we contact your current employer?
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Yes
No
Have you worked for any other employers within the last 5 years? Please list all of them.
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Please Select
Yes
No
Previous Employer
Previous Employers Address
Previous Employers City
Previous Employers Rate Of Pay
Previous Employers Phone Number (xxx-xxx-xxxx)
Previous Employers Reason For Leaving
Previous Employer - list of jobs you held, duties performed, skills used or learned, advancements or promotions.
May we contact this employer?
Yes
No
Please include the names and phone numbers of any other employers you've had within the last 5 years.
Please list any other names or aliases you have ever used for employment purposes.
Use the space below to describe your interest in New Hope Senior Living, along with the skills and aptitudes that you feel qualify you for a position with us:
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Education
What is the highest level of education you have completed?
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Please Select
Never completed High School or GED
High School / GED
College
Graduate School
Other/ Program / Certificate
Personal References
Ref. #1 - Name
*
Ref. #1 - Phone # (xxx-xxx-xxxx)
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Ref. #1 - Relationship
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Ref. #2 - Name
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Ref. #2 - Phone # (xxx-xxx-xxxx)
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Ref. #2 - Relationship
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Ref. #3 - Name
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Ref. #3 - Phone # (xxx-xxx-xxxx)
*
Ref. #3 - Relationship
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Please upload your Resume
Please upload your Photo ID or Drivers License
PLEASE READ CAREFULLY AND CHECK THE BOX NEXT TO EACH PARAGRAPH BEFORE SIGNING THE APPLICATION
I certify that all of the statements made by me on this application and in any interview are true, complete, and correct to the best of my knowledge. I hereby grant permission to New Hope Senior Living and its personnel to confirm by personal inquiry or otherwise the information I give in the employment process. I understand that any willful misrepresentation or omission of facts given in this process is grounds for rejection of this application and dismissal if employed
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I hereby authorize the company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
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I authorize New Hope Senior Living to release to any person, firm, entity, or organization with which I may seek employment in the future, any truthful information concerning my work experience with New Hope Senior Living. I hereby release and hold New Hope Senior Living harmless from any claim for releasing any truthful information within its knowledge and/or records.
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I understand that prior to any job offer extended to me will be contingent upon the successful completion of any required criminal background check, and/or any other drug testing requirement.
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I further understand that, if hired, my employment is for no definite period of time and that either the Company or I may terminate our relationship at will at any time, without notice or any reason, and that this employment application does not constitute an employment contract.
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To sign the application please type your full name:
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Submit