Employment Application Franciscan Care Center


Job Position
Location

First Name
Last Name
Address
City
State
Zip
Phone
Email
Do you have experience at this position?
 Yes
 No
If yes, how many years?
How did you hear about this opening?
Available to work:
 Full-Time
 Part-Time
 PRN/Casual
Shifts:
 Days
 Evenings
 Nights
 Rotating

Special Skills 

Software skills, residential care experience, or areas of specialization you feel may be applicable:

Professional License and/or Certificates

Are you currently:
 Accredited
 Certified
 Licensed
 Registered
If you are accredited, certified or registered please list the type, the state of issuance, the name on the license, expiration dates, and numbers.
Has your license ever been revoked, suspended or been subject to any disciplinary action?
 Yes
 No

Employment Record

Start with your present or most recent employer and list your last three employers regardless of the type of work performed or length of employment.  Be sure to answer all questions. Attaching a resume is not a substitute for completing the application. 

Employer 1

Employer Name
From
To
Job Title & Duties
Reason for Leaving

Employer 2

Employer Name
From
To
Job Title & Duties
Reason for Leaving

Employer 3

Employer Name
From
To
Job Title & Duties
Reason for Leaving
Upload Resume

Release Authorization

By hitting submit, you authorize CHI Living Communities or its affiliates, or agents to conduct a thorough investigation of all statements, written and oral made during the employment application process, including without limitation, information concerning your character or employment positions, law enforcement record, and education background. You hereby authorize all persons, companies, or other entities connected with any such information request, including without limitation, prior employers and law enforcement agencies to provide any and all information they may have regarding you or your employment. You release and agree to indemnify CHI Living Communities, its authorized agents, and its employees, and all other persons, companies, and other entities from any and all liability arising out of such investigation, including without limitation any liability for furnishing information or for taking any action based on the information provided.

Applicant Acknowledgments

1. I hereby certify that all responses set forth during my employment application are true, correct, and complete. I understand and agree that any falsification, misrepresentation, or omission either on the employment application form or in my responses to questions asked during the interviewing or examination process may disqualify me from further consideration for employment, or if employed by CHI Living Communities will subject me to immediate termination, whenever the falsification or omission is discovered. In this regard, when an item is left blank on the employment application, it is because there is no information within its scope.  

2. I acknowledge that, for this type of employment, state law requires a criminal record check as a condition of employment.  

3. I understand and agree if I am employed by CHI Living Communities, my employment is at will so that I may terminate my employment at any time and for any or no reason. Likewise, CHI Living Communities can terminate my employment at any time and for any or no reason. I also understand and agree that nothing contained in the CHI Living Communities employment application or in the granting or conducting of an interview or anything set forth in any oral or written statement, communication, or policy now or in the future constitutes or creates or is intended to constitute or create a contract or promise between me and CHI Living Communities for employment, hours of work, or for the providing of benefits. Moreover, I acknowledge that CHI Living Communities reserves the right to modify, revoke, suspend, terminate or changed any or all of its plans, policies, and procedures at any time, without prior notice. No promises or guarantees regarding employment, hours of work, or for the providing of benefits have been made to me and I understand and agree that no such promise or guarantee is binding on CHI Living Communities unless they are express promises, made in writing, and signed by the Executive Director of CHI Living Communities. 

 I agree to the Release Authorization Terms and Applicant Acknowledgements
Please type your name as your digital signature