Solon Retirement Village, Employment Application

PERSONAL

Were you referred by someone?

Yes
No

If so, whom?

Name

First Middle Last

Present Address (Street, City, State, Zip Code)

Home Telephone Number

Previous Address

Street	City	State	Zip Code	How Long?

Click the + button on the far right to add additional addresses

GENERAL INFORMATION

Have you ever been known by any other name (names) that this facility will require to verify any of the information on this application?

Yes
No

If yes, please list ALL names used

Have you ever been convicted of a crime in this state or any state?

Yes
No

Explain

Are You 18 years Of Age Or Older?

Yes
No

Only U.S. Citizens Or Aliens Who Have A Legal Right To Work In The U.S. Are Elgible For Employment. Can You, Upon Employment, Provide Genuine Documentation Establishing Your Identity And Elgibility To Be Legally Employed In The United States?

Yes
No

Are you a military Veteran?

Yes
No

Dates of Active Duty

Employment Desired

Position Applied For

Resident Assistant (all-shifts)
Life Enrichment Coordinator
Maintenance Coordinator
Culinary Coordinator
Cooks

Date Available For Work?

Wage Expected?

Professional License Number

Expiration Date of License

Please Check Schedule Availability

I am available and desire to work FULL-TIME. Full-Time employees must be available for all/rotating shifts.
I am available and desire to work PART-TIME
I am available and desire to work SEASONAL

I am only available for PART-TIME because:

Student
Other Job
Other

If Other, Explain

Monday: Time Available FROM (A.M. or P.M.) & Time Available TO (A.M. or P.M.)

Tuesday: Time Available FROM (A.M. or P.M.) & Time Available TO (A.M. or P.M.)

Wednesday: Time Available FROM (A.M. or P.M.) & Time Available TO (A.M. or P.M.)

Thursday: Time Available FROM (A.M. or P.M.) & Time Available TO (A.M. or P.M.)

Friday: Time Available FROM (A.M. or P.M.) & Time Available TO (A.M. or P.M.)

Saturday: Time Available FROM (A.M. or P.M.) & Time Available TO (A.M. or P.M.)

Sunday: Time Available FROM (A.M. or P.M.) & Time Available TO (A.M. or P.M.)

Are you able to meet the attendance requirements of the position?

Yes
No

Note: Work Schedules Are Based Upon The Needs Of The Business And May Be Subject To Change On A Weekly Basis.

EMPLOYMENT HISTORY

Begin With Your Most Recent Employment (1) And Continue With Past Employment

Employment #1

Employer

Address

Street Address City State ZIP Code

Employed From

(mm/yyyy)

Employed To

(mm/yyyy)

Starting Salary

Ending Salary

Your Title(s)

Your Duties

Reason for Leaving

Name & Title of Supervisor

Phone Number

Type of Business

May We Contact Employer?

Yes
No

Employment #2

Employer

Address

Street Address City State ZIP Code

Employed From

(mm/yyyy)

Employed To

(mm/yyyy)

Starting Salary

Ending Salary

Your Title(s)

Your Duties

Reason for Leaving

Name & Title of Supervisor

Phone Number

Type of Business

May We Contact Employer?

Yes
No

Employment #3

Employer

Address

Street Address City State ZIP Code

Employed From

(mm/yyyy)

Employed To

(mm/yyyy)

Starting Salary

Ending Salary

Your Title(s)

Your Duties

Reason for Leaving

Name & Title of Supervisor

Phone Number

Type of Business

May We Contact Employer?

Yes
No

May we contact former employees to verify this information?

Yes
No

Explain Any Period Between Jobs

Please provide any additional information about your abilities or interests that make you a good candidate for this position and why you chose our facility.

ATTENDANCE AND PUNCTUALITY INFORMATION

Consistent attendance and punctuality are essential requirements of every job with this business. Is there anything which would interfere with your regular attendance and punctuality if you are offered a job with this business?

Yes
No

EDUCATION

Education History - List High School and any post High School education. Click the + button on the far right to add additional high schools, colleges, universities, technical colleges, or trade schools

Type of School	Name and Address Of School	Major Subject	Highest Grade Or Year Completed	Graduate?	Degree

Click the + button on the far right to add additional high schools, colleges, universities, technical colleges, or trade schools

Area of concentration and/or degree(s), certificates, license, endorsements

Other training or skills

(factory or office machines operated, special course, etc)

Military

Military Training or Experience

PERSONAL OR BUSINESS REFERENCES

Add 4 References

Name	Occupation Business Phone Number	Telephone Number	Title/Relationship

Click the + button on the right to add additional references

Resume

If you have an electronic version (Word, PDF, etc.) of your resume, you may attach it here.

NOTIFICATION AND AGREEMENT

Applicant Statement

I CERTIFY THAT ALL ANSWERS GIVEN BY ME ARE TRUE, ACCURATE AND COMPLETE, I UNDERSTAND THAT THE FALSIFICATION, MISREPRESENTATION OR OMISSION OF FACT ON THIS APPLICATION (OR ANY OTHER ACCOMPANYING OR REQUIRED DOCUMENTS) WILL BE CAUSE FOR DENIAL OF EMPLOYMENT OR IMMEDIATE TERMINATION OF EMPLOYMENT, REGARDLESS OF WHEN OR H0W DISCOVERED.

Questions regarding this statement should be directed to any employment interviewer before signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed.

It is the policy of the company to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, marital status, expunged juvenile records, or pregnancy, and to afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability, any and other characteristic protected by Federal, State or Local law.

I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information and I also release the employer from all liability that might result from making an investigation.

If hired, I agree to abide by all of the company rules and regulation, and understand that, if employed, my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either the company or me, I further understand that no representation, whether oral or written by any representative or agent of the Company, at any time, can constitute a contract of employment. I understand that the Company and all Plan Administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, benefits or other terms or conditions of employment. No representative or agent of the company, has the authority to enter into any agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other term or condition of employment other than in a document signed by the President or Executive Vice President, or to make any agreement contrary to the foregoing.

I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me

Signature (Type your initials)

DO NOT SUBMIT UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT

Today's Date

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Employment Application

PERSONAL

GENERAL INFORMATION

Employment Desired

EMPLOYMENT HISTORY

Employment #1

Employment #2

Employment #3

ATTENDANCE AND PUNCTUALITY INFORMATION

EDUCATION

Military

PERSONAL OR BUSINESS REFERENCES

NOTIFICATION AND AGREEMENT

Solon Nursing Care Center

Solon Assisted Living Village

Terrace Lane/Terrace Lane Glen Independent Condos