Apply - The Manor

PERSONAL INFORMATION

Name(Required)

First Last

Social Security Number

Driver's License Number

Driver's License Expiration Date

Date of Birth(Required)

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Position(s) Applying For

Referral Source(Required)

Walk In

Employee

Other

Please check appropriate category and name the source.

Name of the Referral Source

Have you submitted an application here before?(Required)

Yes

No

If yes, when did you apply?(Required)

If yes, what was the position you applied for?(Required)

Have you been employed here before?(Required)

Yes

No

Enter your start date.(Required)

Enter your end date.(Required)

What is your desired salary range $(Required)

Date Available for Work(Required)

Type of Employment Desired

Full-time

Part-time

Will you work overtime if required?(Required)

Yes

No

If No, please explain.(Required)

Shift Desired(Required)

Check All that Apply. Shifts are filled based on availability on a first-come first-served basis

Are you presently employed?

Yes

No

May we contact your present employer?(Required)

Yes

No

If Yes, work # and best time to call.(Required)

Are you legally eligible for employment in this country?(Required)

Yes

No

If you are under 18 and it is required, can you furnish a work permit?

Yes

No

To what job-related organizations (professional, trade, etc.) do you belong?(Required)

Exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran / reserve, National Guard or any other similarly protected status.

Special accomplishments, publications, awards, etc.(Required)

Exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran / reserve, National Guard or any other similarly protected status.

List here any other job-related information you want us to know about you.(Required)

In your current or prior job, have you ever written instructions or directions to be followed by employees or customers?

Yes

No

Not applicable

If Yes, please explain.(Required)

Driver’s License Number

Required if driving might be required in the job for which you are applying.

Driver's License State(Required)

License Expiration Date(Required)

Have you ever pled “guilty” or “no contest” to, or been convicted of a crime?(Required)

Yes

No

If Yes, please provide date(s) and details.(Required)

EDUCATION HISTORY

High School Name

Years Completed

Relevant Classes

List classes related to the position(s) for which you're applying.

Diploma

Yes

No

Other

College Name

Years Completed

Major Course

List your Major, Minor, and/or relevant courses to the position(s) for which you're applying.

Degree

Yes

No

Other

Business or Trade School Name

Years Completed

Major Coursework

List your relevant coursework to the position(s) for which you're applying.

Vocational Certificate

Yes

No

Other

SKILLS

Have you served in the United States Armed Forces?

Yes

No

If Yes, briefly describe the skills you acquired.

Summarize any special training, skills, licenses and/ or certificates that may assist you in performing the position for which you are applying.

List equipment and computer skills.

EMPLOYMENT HISTORY

Starting with your most recent employer, provide your employment history for the last 7 years.

Employer Name

Starting Job Title / Final Job Title

Start Date

End Date

Employer Phone

Employer Address

Street Address City State / Province / Region

Immediate Supervisor and Title

(For most recent position held.)

Why did you leave?

(Or desiring to leave.)

Summarize job responsibilities and type of work performed.

What did you like most about your position?

What did you like least about your position?

Starting Compensation

Final Compensation

Other Compensation

EMPLOYMENT HISTORY (continued)

Starting with your most recent employer, provide your employment history for the last 7 years.

Employer Name

Starting Job Title / Final Job Title

Start Date

End Date

Employer Phone

Employer Address

Street Address City State / Province / Region

Immediate Supervisor and Title

(For most recent position held.)

Why did you leave?

Summarize job responsibilities and type of work performed.

What did you like most about your position?

What did you like least about your position?

Starting Compensation

Final Compensation

Other Compensation

EMPLOYMENT HISTORY (continued)

Starting with your most recent employer, provide your employment history for the last 7 years.

Employer Name

Starting Job Title / Final Job Title

Start Date

End Date

Employer Phone

Employer Address

Street Address City State / Province / Region

Immediate Supervisor and Title

(For most recent position held.)

Why did you leave?

Summarize job responsibilities and type of work performed.

What did you like most about your position?

What did you like least about your position?

Starting Compensation

Final Compensation

Other Compensation

Explain any gaps in your employment.

(Other than those due to personal illness, injury or disability).

If not addressed on previous page, have you ever been fired or asked to resign from a job?(Required)

Yes

No

If Yes, please explain:(Required)

AGREE AND SIGN

APPLICANT STATEMENT(Required)

I agree with the following applicant statement.

I certify that all information I have provided in order to apply for and secure work with United Methodist Manor is true, complete and correct.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interviews. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees and representatives. For seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreement(s) contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s President.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer’s service, whenever it is discovered.

Signature(Required)

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

Date Signed

Name

This field is for validation purposes and should be left unchanged.

Apply Online for Positions at The Manor

PERSONAL INFORMATION

EDUCATION HISTORY

SKILLS

EMPLOYMENT HISTORY

EMPLOYMENT HISTORY (continued)

EMPLOYMENT HISTORY (continued)

AGREE AND SIGN