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Application for Employment

It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability or other protected classifications.

Please carefully read and answer all questions. You will not be considered for employment if you fail to completely answer all the questions on this application. You may attach a resume, but all questions MUST be answered.

PERSONAL DATA

Birthday
Month
Day
Year
Do you have a High School Diploma or GED?

POSITION INFORMATION

Hours
Status:
Shifts
Are you authorized to work in the U.S. on an unrestricted basis?
Have you had a caregiver background check within the last 12 months? IF, one is needed here is the link. https://recordcheck.doj.wi.gov/
Have you even been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment) If yes, explain:
Have you been told the essential functions of the job or provided with a copy of the job description listing the essential functions of the job?
Can you perform these essential accommodations?

QUALIFICATIONS Please list any education or training you feel relates to the position applied for that would help you with your work. Such as schools, colleges, degrees, or vocational, technical programs or military trainings

SPECIAL SKILLS

REFERENCES

WORK HISTORY

Date
Month
Day
Year
Date
Month
Day
Year
Date
Month
Day
Year

I certify that the facts set forth in this application of employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentation may result in my dismissal. I authorize the employer to make an investigation of any of the facts set forth in this application and release the employer from any liability. The employer may contact any listed references on this application.

I acknowledge and understand that the company is an "at will" employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.

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