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Hennis Care Centre

Employment Application

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, martial, or veteran status, or any other legally protected status.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER.

Name
 
Address
 
Phone
 
License or certification number, if applicable
 
Best time to contact you at home
 
Position Applied For
 
If you are under 18 years of age, can you provide required proof of your eligibility to work?
 
Have you ever filed an application with us before?
   If yes, please provide date
Have you ever been employed with us before?
   If yes, please provide date
Do any of your friends relatives, other than spouse, work here?
   If yes, state name, relationship and location
Are you currently employed?
   If yes, may we contact your current employer?
Are you prevented from lawfully becoming employed in the United State because of VISA or Immigration Status?
   Proof of citizenship, immigration status, and right to work in the US will be required upon employment
Are you currently laid off and subject to recall?
 
Date available for work
 
What is your desired salary range?
 
Are you available to work:

WORK EXPERIENCE

List your current job first, then your previous employment history. Include any job related military service assignments, and volunteer activities

Employer
Address
Telephone Number(s)
Starting/Present Job Title
Supervisor/Manager

May we contact?
Reason for Leaving
Dates Employed
Start Date End Date
Hourly Rate/Salary
Beginning Ending
Duties/Work performed
 
Employer
Address
Telephone Number(s)
Starting/Present Job Title
Supervisor/Manager

May we contact?
Reason for Leaving
Dates Employed
Start Date End Date
Hourly Rate/Salary
Beginning Ending
Duties/Work performed
 
Employer
Address
Telephone Number(s)
Starting/Present Job Title
Supervisor/Manager

May we contact?
Reason for Leaving
Dates Employed
Start Date End Date
Hourly Rate/Salary
Beginning Ending
Duties/Work performed
Please explain any gaps in your employment history

EDUCATION

  Name And Address of School Course of Study
Years 
Completed
Diploma / 
Degree
High School
Undergraduate college
Graduate Professional
Technical/Specialty
Other

LIFE EXPERIENCE

Describe any specialized training, apprenticeships, skills or extra curricular activities.
Describe any job related training received in the United State military.
Describe any professional, trade, business, civic or other activities or office you have held.
Describe any other job related skills, qualifications or experiences.

PERSONAL/PROFESSIONAL REFERENCES

Do not include family members or past supervisors/managers.

Name Phone Number Occupation Best Time
to Call
       
       
       

APPLICANT'S STATEMENT

I certify that all answers given herein are true and complete. I authorize the investigation of all statements contained in the application for employment as may be necessary in arriving in an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant who desires to be considered for employment past 45 days should inquire as to whether or not applications are being accepted at that time. I hereby understand and agree that any employment relationship with Hennis Care Centre, a smoke free facility, is of an "AT WILL" nature, which means that the employee may resign at any time and Hennis Care Centre may discharge the employee at any time with or without cause or notice. It is further understood that this "AT WILL" employment relationship may not be changed by any written documentation or verbal authority unless such change is authorized and specifically acknowledged in writing by the President of Hennis Care Centre. In the event of employment, I understand that false or misleading information given on my application or during an interview(s) may result in termination of employment. I understand that I will be required to abide by all the policy and procedures, rules and and regulations of Hennis Care Centre.

 

Signature:  

 

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