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Application For Employment

Maple Lawn Nursing Home, Inc. does not discriminate its employment or admission practices on the basis of race, color, creed, religion, national origin, sex, disability, age, marital status, or status with regard to public assistance, sexual orientation, membership in local commission, genetic information, or any other characteristic protected under federal, state or local law.

 

Maple Lawn’s policy applies to all aspects of employment, including recruitment, hiring, job assignments, promotions, working conditions, scheduling, benefits, wage and salary administration, disciplinary action, termination, and social, education and recreational programs. Maple Lawn intends to comply with all applicable Equal Employment Opportunity-Affirmative Action laws, directives and regulations of Federal, State and Local governing bodies or agencies.

PERSONAL INFORMATION

FIRST NAME
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MIDDLE
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LAST NAME
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EMAIL
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ADDRESS
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CITY
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STATE
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ZIP
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PHONE
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CELL PHONE
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SS NUMBER
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HOW LONG HAVE YOU LIVED AT THE ABOVE ADDRESS?
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  • 0 - 10 yr
  • 10 - 20 yr
  • 20 - 30 yr
  • 30 - 40 yr
  • 40 - 50 yr
  • 50 - 60 yr
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PREVIOUS ADDRESS
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HOW LONG DID YOU LIVE THERE
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  • 0 - 10 yr
  • 10 - 20 yr
  • 20 - 30 yr
  • 30 - 40 yr
  • 40 - 50 yr
  • 50 - 60 yr
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EMPLOYMENT INFORMATION

POSITION DESIRED
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SALARY EXPECTED
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DATE AVAILABLE
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ARE YOU EMPLOYED
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IF SO, MAY WE INQUIRE OF YOUR PRESENT EMPLOYER?
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EVER APPLIED TO THIS COMPANY BEFORE?
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WHEN?
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DEPARTMENT?
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ARE YOU LEGALLY ELIGIBLE TO WORK IN U.S.?
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ARE YOU A VETERAN?
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HOW DID YOU HEAR ABOUT US?
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  • ONLINE
  • NEWSPAPER
  • SCHOOL
  • RADIO
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EDUCATION

High School
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College/University
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Business/Technical/Correspondence School
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Other
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LIST LICENSES, AWARDS, CERTIFICATIONS, OR REGISTRATIONS PERTINENT TO YOUR APPLICATION.
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EMPLOYMENT HISTORY

(LIST BELOW LAST FOUR EMPLOYERS, STARTING WITH LAST ONE FIRST)

Job 1

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Job 2

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Job 3

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Job 4

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REFERENCES

IMPORTANT: List below the names and addresses of three personal references, excluding former employers and relatives.
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ADDITIONAL INFORMATION

Please list any other job-related information you think would be helpful to us in considering you for the position, such as any additional work experience, volunteer activities, hobbies, social activities, clubs or professional organizations (list offices held), publications, accomplishments, etc.
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By submitting this application, I certify the answers in this application are true to the best of my knowledge.
nI understand this application for employment authorizes any representative of Maple Lawn Senior Care to investigate any information given on the application and releases same from any and all liability resulting from such investigation.
nI understand that I must establish my right to work in the United States by documents acceptable to the Immigration and Naturalization Service within three business days of being asked to commence work or any employment offer will be rescinded by operation of law. (Immigration Reform and Control Act of 1986)

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Date
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