Job Application

Job Application

(Note: * required fields.)

Section I: Equal Employment Opportunity Employer

Freighter View Assisted Living Community is an equal opportunity employer. It is the policy of this organization not to discriminate on the basis of race, sex, religion, national origin, marital status, age, weight, height, color, disability or veteran status in the hiring, promotion, compensation or discipline of employees. If you are a person with a disability, you may request any needed reasonable accommodation to participate in the application process or interview process. Michigan law requires that a person with a disability or handicap requiring accommodation for employment must notify the employer in writing within 182 days after the need is known.

 

Section II: Pre-Employment/Employment Substance Screening

It is the policy of the employer to maintain a drug and alcohol free environment. The employer reserves the right to require new hires to submit to a substance screen as one of the contingencies established in the conditional job offer. The employer has a zero tolerance for the use and/or abuse of drugs and/or of alcohol.

 

Section III: Applicant Information

YesNo
YesNo

Name and address of person to be notified in case of an emergency:

YesNo
(Answering "yes" to this inquiry will not automatically disqualify you.)
YesNo
(Answering "yes" to this inquiry will not automatically disqualify you.)
YesNo
YesNo
YesNo
 

Section IV: Availability and Interests in Work

Full TimePart Time

On which days and shifts are you AVAILABLE to work?

MorningAfternoonEvening
MorningAfternoonEvening
MorningAfternoonEvening
MorningAfternoonEvening
MorningAfternoonEvening
MorningAfternoonEvening
MorningAfternoonEvening

 

Section V: Education

Name, Street, City, State
YesNo
Name, Street, City, State
YesNo
Name, Street, City, State
YesNo
 

Section VI: Professional Licenses, Certifications and Credentials

Do you have any of the following licenses or certifications?


YesNo


YesNo


YesNo

 

Section VII: Employment History

(Please start with current or most recent employer)






Employment Dates: (Month/Year)
Hourly Pay:






Employment Dates: (Month/Year)
Hourly Pay:






Employment Dates: (Month/Year)
Hourly Pay:


YesNo



Name, Title, Phone
 

Section VIII: References

Please give the names of 2 PERSONAL references from persons not related to you, whom you have known for at least 1 year:

Personal







Professional

Please give the names of 2 PROFESSIONAL references from supervisors, managers, administrators, or executive directors form whom you have worked for:








 

Section IX: Consent

I hereby give you my permission to contact the above employers, references, educational, licensing, and credentialing and certification institutions to verify the items I listed above. I hereby release Freighter View Assisted Living and the above referenced organization, reference persons and employers from all claims, liability and damages that may result from furnishing this information to you. I consent to releasing any information relating to my job performance, which is documented in my personnel file. In the event that a prior employer or other organization is obligated to provide any written notice to me regarding the disclosure of information to Freighter View Assisted Living, I hereby waive the obligation and expect no written notice of disclosure of my personal information.

I also understand that because of the nature of my job and licensing requirements, I hereby consent to the release of this application or portions of this application to representatives of the Department of Human Services, Department of Community Health, local community mental health entities and other governmental agencies or private agencies, for all licensing or investigatory purposes and to verify information I have listed in this job application. I hereby release Freighter View Assisted Living, The Department of Human Services, Department of Community Health, local community mental health entities and other governmental agencies or private agencies from all claims, liability, and damages that may result from furnishing this information to you.

I further specifically waive written notice and agree to the divulging of any disciplinary reports, letters of reprimand or other disciplinary action by all prior employers, and hereby release any prior employers from all claims, liability and damages that may result from furnishing this information to you.

I certify that all of the information provided on this application is true, complete and correct. I further understand and agree that any falsification, misrepresentation or omission of fact on this application or in any interviews or pre-employment process are grounds for disqualification for consideration for employment or termination of employment if the discovery Is made after employment begins.

This application will be kept on file for 3 months. You need to complete another application to be reconsidered after this date.

 

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