Application for Employment -CR-Senior Care

Application for Employment - Cornerstone Residence Senior Care

Located: 421 6th Street NE . Bagley, MN 56621 . 218-435-2378
Please Read the Following Statement Before Completing this Employment Application

Cornerstone Residence, Inc. is an Equal Opportunity Employer. We consider Applicants of all positions without regard to race, religion, creed, gender, national origin, age, marital or veteran status, sexual orientation, status with regard to public assistance, or any other legally protected status.

All offers of employment shall be considered conditional based upon the following conditions: Accurate completion of this and all employment forms; negative results of tuberculin test; the ability to access information on the status of RN, LPN or CNA licensure or certification (if applicable), driving record; and legally eligible for employment in the United States of America.
Today's Date*

MonthDayYear
Date
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Previous Names or Aliases
Current Address*

Street Address

Street Address Line 2

CityState

Zip Code
Previous Address (if less than a year ago)

Street Address

Street Address Line 2

CityState

Zip Code
Position(s) Applying for*
Pay Expected
Shift(s) Preferred

DaysAfternoons/EveningsOvernights
Shift Preferred

123
Do you prefer full or part-time work?

Full-TimePart-Time
Have you ever applied for employment with us before?

YesNo
If yes, give the date

MonthDayYear
Date
Have you ever been employed with us before?

YesNo
If yes, give dates and position
Are you legally eligible for employment in the United States? Proof is required.

YesNo
Are you of legal age to work in the United Sates

YesNo
Are you a Registered Nurse, Licensed Practical Nurse, or Certified Nursing Assistant? Enter Your License/Certification#
Do you have any special training or skills related to the position(s) applied for?
Professional or Civic organization membership (Exclude any which may disclose a protected class)
Please write a few sentences telling us why you have chosen to work in health care.
Education
Did You Graduate from? (Select if "Yes")

Grammar SchoolHigh SchoolCollegeGraduate SchoolBusiness/Technical
Please list the name of the schools attended, their location, and the course of study.
Employment Experience

Please list beginning with the most recent
Please upload your resume or complete the employment section below

Cancelof
Employer Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Type of Business
Supervisor

First NameLast Name
Dates of Employment
Job Title
Describe the work performed
Reason for leaving
Add another employer

Yes
Employer Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of Business
Supervisor

First NameLast Name
Dates of Employment
Job Title
Describe the work performed
Reason for leaving
Add New Employer

Yes
Employer Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of Business
Supervisor

First NameLast Name
Dates of Employment
Job Title
Describe the work performed
Reason for leaving
Add New Employer

Yes
Employer Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of Business
Supervisor

First NameLast Name
Dates of Employment
Job Title
Describe the work performed
Reason for leaving
Please explain any intervals between employment dates of three (3) months or longer.
References

Please provide name and contact information
Name of Reference #1*

First NameLast Name
Please indicate if this is a personal or professional reference.*

PersonalProfessional
Relationship of Reference*
Phone Number*
Please enter a valid phone number.
Phone Number*
Please enter a valid phone number.
Name of Reference #2

First NameLast Name
Please indicate if this is a personal or professional reference.

PersonalProfessional
Relationship of Reference
Phone Number
Please enter a valid phone number.
PLEASE READ CARFULLY AND SIGN BELOW

I certify that to the best of my knowledge, the facts contained on my application are true and correct, without substantial omissions. I understand that if I am chosen for employment, any false information on this application may result in immediate discharge. I further understand this application is not and is not intended to a contract of employment, nor does this application obligate Cornerstone Residence in any way, if they decide to employ me. I understand and agree that any employment is at-will and can be terminated by either party with or without notice, at any time, for any reason or no reason.

Cornerstone Residence is an Equal Opportunity Employer. We consider Applicants of all positions without regard to race, religion, creed, gender, national origin, age, marital or veteran status, sexual orientation, status with regard to public assistance, or any other legally protected status.

I agree to submit to a Mantoux test, or chest x-ray, if a previous Mantoux test has been positive, in compliance with the State of Minnesota Department of Health Regulation 4655.3000, subparts 1-4.

I further understand, that if I am employed by Cornerstone Residence, and upon completion of that employer/employee relationship, my signature below gives Cornerstone Residence the permission to release information related to my employment, including, but not limited to: dates of employment and positions held.
Today's Date*

MonthDayYear
Date
Signature*

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Application for Employment - Cornerstone Residence Senior Care

Education

Employment Experience

References