Employment Application

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a pre-employment drug screening and/or medical examination. This application will remain active for one year.
Job Posting Select Posting to Apply for: 
Personal Information
First Name *: Middle Name *: Last Name *:
Home Phone *: Work Phone : Cell Phone :
Email Address *:

Addresses
Street *: City *: State *: Zip Code *: Since (Mo/Yr) : To (Mo/Yr):
Current Address *:
Education
School Attended: City: State: Diploma Deg/Cert/Dip (provide Lic. # if applicable) Area of Study
High School GED
Undergrad School:
Grad School:
Other School:
Employment Information
Additional Positions Applying For Date You Can Start calendar (yyyy-mm-dd) Desired Salary: $
Do You Prefer Can you work  Weekends
 Evenings		 Available: M Tu W Th F Sa Su
Not Available
Please answer all of the following questions.
1. Are you at least 18 years of age and legally eligible to work for our company in the United States?
2. Have you worked at Pleasant View before?
If yes, please provide dates and locations.
3. Have you ever been dismissed from employment due to abuse of residents or clients?
4. Can you perform the essential functions of the job with or without reasonable accommodations?
If no, please explain.
5. Have you ever been discharged or asked to resign from a job?
If yes, please explain...
6. Have you ever been convicted of or pled guilty to a felony or crime other than a minor traffic citation?
If yes, please explain (a conviction is not an absolute bar to employment, but will be considered if it relates to fitness and ability to perform the job.)
Employment History
May we contact your present employer?
Most Recent Employer Prior Employer Prior Employer Prior Employer
Employer :
City :
State :
Zip Code :
Phone :
Position Held :
From (m/yyyy) :
To (m/yyyy) :
Pay Upon Leaving :
Supervisor :
Duties :
Reason For Leaving :
References
Reference (1) Reference (2) Reference (3) Reference (4)
Name :
Address :
Telephone :
Relationship :
Years Acquainted :
Resume (Text Version)
Copy and Paste a text version of your resume here.
Upload File
Attach a file to your application submission
Applicant's Certification Agreement
1. The company and other persons or employers are released from all liability brought forth by any investigation resulting from my submission of this electronic application and the data contained here in.
2. The information in this application is true and complete to the best of my knowledge. Any falsification, misrepresentation, or omission on this application can be cause for denial or termination of employment.
3. If hired, my employment is voluntary, meaning that either party can terminate employment at any time for any reason. Upon acceptance of employment if a position is offered, I agree to abide by all existing and future company rules and regulations. The company reserves the right to change any working agreement as deemed necessary.
4. Any employment offer is contingent upon my providing proof of identity and eligibility to work in the country of employ.
5. I have read and reviewed the information provided in this application and the above statements. By typing my name in the signature box below this application for employment I certify that I understand all parts of it and have answered all questions completely and fully.
6. I understand that by submitting this application electronically, my application will be reviewed and maintained on file for one year. I further understand that a Pleasant View representative will contact me if they wish to interview me.
Type Name in Signature Box*: Today's Date: 2010-09-07 04:16:18
EDT