Application for Employment

Required fields are marked with an asterisk*

Employment status applying for

Are you legally qualified to work in the U.S.?*

Are you under the age 18?*

With or without reasonable accommodation, are you able to perform essential functions of the job for which you are applying?*

Do you have reliable transportation?*

Have you been convicted of a crime involving mistreatment, neglect, abuse, homicide, sex offenses, domestic violence, theft, fraud, misappropriation of another person's property, conspiracy, weapons, or drugs?*

Can you work weekends?

Can you work overtime?

Did you graduate?

May we contact this employer?*

May we contact this employer?*

May we contact this employer?*

I CERTIFY THAT ALL INFORMATION CONTAINED IN THIS APPLICATION IS TRUE, AND UNDERSTAND THAT ANY MISLEADING OR FALSE INFORMATION OR WILLFUL OMISSION WILL BE SUFFICIENT CAUSE FOR IMMEDIATE DISMISSAL OR REFUSAL OF EMPLOYMENT. I UNDERSTAND THAT ALL INFORMATION IN THIS APPLICATION IS SUBJECT TO VERIFICATION AND THAT THE FACILITY MAY INVESTIGATE MY WORK AND PERSONAL INFORMATION AND VERIFY ALL DATA GIVEN ON THIS APPLICATION. I ALSO AUTHORIZE ALL INDIVIDUALS, SCHOOLS, BUSINESSES AND EMPLOYERS (PAST AND PRESENT), AND REFERENCES HEREIN, EXCEPT MY CURRENT EMPLOYER IF SO NOTED, TO PROVIDE ANY INFORMATION REQUESTED ABOUT ME, AND I RELEASE THEM FROM ALL LIABILITY FOR DAMAGE IN PROVIDING THIS INFORMATION. I FURTHER UNDERSTAND THAT EMPLOYMENT IS “AT-WILL” AND THAT NOTHING CONTAINED IN THIS EMPLOYMENT APPLICATION OR STATEMENTS MADE DURING THE INTERVIEW PROCESS IF AN INTERVIEW IS GRANTED, ARE INTENDED TO CREATE AN EMPLOYMENT CONTRACT BETWEEN THE FACILITY AND MYSELF FOR EITHER EMPLOYMENT OR FOR THE PROVIDING OF ANY BENEFIT.

AN EQUAL OPPORTUNITY EMPLOYER
ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, DISABILITY, VETERAN STATUS, OR ANY OTHER CHARACTERISTIC PROTECTED BY LAW. PLEASE DIRECT ANY REQUEST FOR REASONABLE ACCOMMODATIONS NEEDED DURING THE APPLICATION PROCESS TO AN ADMINISTRATOR.