Caring Acres Nursing and Rehab Center
An Equal Opportunity Employer
Application for Employment
We consider applicants for all positions without regard to race, color, religion, gender, national origin, age, marital or veteran status, the presence of non-job-related medical condition or disability, or any other legally protected status.
First Name:*

Middle Initial

Last Name:*

Address Line 1:*

Address Line 2:

City:*

State:*

Zip Code:*

Cell Phone:*

Business Phone:

E-Mail:*

Work Preference
Date Available*

Postion Applied For:*

Licenses / Certifications Held

Employment Requested*
Full Time Part Time Temporary 

How Did You Learn About This Position?*
Facebook Ad Newspaper Friend Relative Current Caring Acres Employee 

Education
High School Name/Location:*

Diploma Received:*
Diploma Equivalency None 

College Name/Location:

Degree Earned:

Attended from:

Attended To:

Major/Minor:

Employment History
Name Of Current Employer:*

Address Line 1:*

Address Line 2:

City:*

State:*

Zip Code:*

Start Date:*

Employer Phone:*

Current Wage*

Job Title:*

Supervisor Name:*

Reason For Leaving:*

Previous Employer:*

Address Line 1:*

Address Line 2:

City:*

State:*

Zip Code:*

Employed From:*

Employed To:*

Employer Phone:*

Job Title:*

Supervisor Name:*

Reason For Leaving:*

Professional References
Please list three references that have knowledge of your professional experience.
Reference Name:*

Phone Number*

Reference Name:*

Phone Number*

Reference Name:*

Phone Number*

Background
ARE YOU ABLE TO PERFORM THE ESSENTIAL DUTIES OF THE JOB FOR WHICH YOU ARE APPLYING?*
Yes No 

CAN YOU TRAVEL IF A JOB REQUIRES IT?*
Yes No 

HAVE YOU EVER BEEN CONVICTED OF A FELONY OR A FIRST DEGREE MISDEMEANOR?*
Yes No 

HAVE YOU EVER HAD ANY JOB-RELATED TRAINING IN THE UNITED STATES MILITARY?
Yes No 

ARE YOU AUTHORIZED TO WORK LAWFULLY IN THE UNITED STATES?*
Yes No 

Applicant`s Statement
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 180 days.

I hereby understand and acknowledge that any employment relationship I may have with Caring Acres, LLC is of an “at will” nature, which means that I may resign at any time and Caring Acres, LLC may discharge me at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by the President of Caring Acres, LLC. I further confirm I have reviewed the job description and physical requirements of the job and can fulfill all responsibilities.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. In the event an offer of employment is extended, I acknowledge that this offer may be withdrawn for any reason prior to my start date - which is considered to be the first day on the actual facility floor and does not include day of business paperwork in accordance with Federally mandated payroll based journalling. I understand, also, that I am required to abide by all rules and regulations of the employer, and will be subject to a 90 day introductory period.

I have reviewed the job description and physical requirements of the job and can fulfill all responsibilities. I hereby authorize my former employer(s) and listed references to furnish all information pertaining to my work record and person
and release my former employer(s) and listed references from all liability on account of furnishing such information to this company.
By typing your name below and clicking submit you certify the answers given herein are true and complete to the best of my knowledge.
Please Type Full Name*

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