Havelock Manor considers all applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, marital or military status, or based on any individual's status in any group or class protected by applicable federal, state. or local law. Havelock Manor also provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require an accommodation in the application process, please advise Management.Date(Required) MM slash DD slash YYYY Name(Required) First Middle Last Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell PhoneEmail(Required) Are you a US citizen or otherwise authorized to work in the US on an unrestricted basis?(Required)(You may be required to provide documentation.) Yes No Are you looking for full-time employment? Yes No What hours are you available?Are you willing to work day shift?(6am - 2:30pm) Yes No Are you willing to work swing shift?(2pm - 10:30pm) Yes No Are you willing to work graveyard shift?(10pm - 6:30am) Yes No PRN staffing to fill in on open shiftsEmployment DesiredPosition Applied for:Desired SalaryHow did you hear of this opening?Special training/Certification for position: 40 hour Medication Aide L.P.N. CPR C.N.A. Food Handlers Permit Have you ever applied for employment here? Yes No When?Have you ever been employed by this company? Yes No When?Are you presently employed? Yes No May we contact your present employer? Yes No Date you can start: MM slash DD slash YYYY Please list any applicable skills:EducationSchools School Name and Location Year Major Degree Actions Edit Delete There are no Entries. Add School Maximum number of entries reached. In addition to your work history are there any other skills, qualifications, or experiences that we should consider?Please list any scholastic honors received and offices held in school:Are you planning to continue your studies? Yes No Where and what courses of study?Have you ever done any volunteer work? Yes No Describe:Employment History(Start with most recent employer)Employment Company Name: Date Started: Date Ended: Actions Edit Delete There are no Employments. Add Employment Maximum number of employments reached. ReferencesList three personal references, not related to you, who have known you for more than one year.References Name: Phone: Years known: Actions Edit Delete There are no References. Add Reference Maximum number of references reached. Emergency ContactIn case of emergency please notify:Emergency Contacts Name: Phone: Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Please Read Before Signing:I certify that all information provided by me on this application is true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application. I authorize my previous employers, schools, or persons listed as references to give any information regarding employment or educational record. I agree that this company and my previous employers will not be held liable in any respect if a job offer is not extended, or is withdrawn, or employment is terminated because of false statements, omissions, or answers made by my self on this application. In the event of any employment with this company, I will comply with all rules and regulations as set by the company in any communication distributed to the employees. In compliance with the Immigration Reform and Control Act of 1986, I understand that I am required to provide approved documentation to the company that verifies my right to work in the United States on the first day of employment. I have received from the company a list of the approved documents that are required. I understand that employment at this company is "at will", which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I hereby acknowledge that I have read and understood the above statements.SignatureDate MM slash DD slash YYYY Upload Additional FilesResume, Letter of Recommendation, etc. Drop files here or Select files Accepted file types: doc, docx, pdf, txt, Max. file size: 16 MB. PhoneThis field is for validation purposes and should be left unchanged.
