SPLENDID CARE EMPLOYMENT APPLICATION

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EMPLOYMENT APPLICATION
INSTRUCTIONS: You must complete all parts of the application. Read the job announcement carefully before you apply. Announcements may contain special instructions and requirements.
- Submit a separate application for each job. Type clearly.
- If your application is incomplete or does not clearly show the experience and/or training required, your application will be rejected.
- Resumes may be submitted with the application, but not in lieu of a completed application.
- For jobs with an experience and training requirement, your eligibility will be determined by an evaluation of the job-related experience and training you describe on the application form.
- Your application and all attachments become the property of Splendid Care and will not be returned. Keep a copy of your completed application form if necessary. A PDF report including all of your answers will be emailed to you automatically when you submit the form.
- Also at the bottom of the "Thank You" page, received after completion of each form, will be buttons to take you to the Attestation and Document Upload forms. Both of these are part of the application process and will need to be completed. This page also includes a button giving you the option to edit or add to your submission.
- On the bottom of each page of the form is a save button that will allow you to save and complete the form at a later time. You will be emailed a link that will take you back to the application preserving your completed answers.
You are welcome to submit an application whether or not there are any jobs available at the time. However, your application will only be kept for thirty (30) days and you must call the Administrative Office to have your application considered for a specific position that is advertised.

APPLICANT NOTE: The application must be fully completed to be considered. Please complete each section, even if you attach a resume.

We are an Equal Opportunity Employer and committed to excellence through diversity.

Application Begin

This Section of the App should take about 20 Minutes.
Today’s Date

MonthDayYear
Date
Positions(s) for which to Apply:

Direct Support ProfessionalNurse AideCertified Nurse Assistant (CNA)Other

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PERSONAL INFORMATION

All information on this page is required and must be completed in order to advance to the next page and finish the application process. Though not required, please try to fill out as many sections as possible.
Name*

PrefixFirst NameMiddle NameLast NameSuffix
SSN*
Enter SSN
Date Of Birth*

MonthDayYear
Date
Mobile Phone*
E-Mail*
example@example.com
Please upload your resume

You will have the option to upload the file from your device or take a picture.
Cancelof

Addresses (Current and Previous)
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

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Additional Points of Contact/Emergency Contact Info

So that we may reach you ion a timely manner
Home Phone
Work Phone
Alternate Phone
Social Media Info (Optional)

Please Provide any of your Social Media info if that is an acceptable way of contacting you. We will of course try your phone numbers and email address before using Social Media.
Facebook
Instagram
Twitter
Tik Tok
WhatsApp
Please list any other Social Media or alternate ways of contact below
Smoke Signal, Pager,
Emergency Contact Info

Please Provide the person we need to call if an emergency arises.
Emergency Contact Name
Emergency Contact(s) Number
Please enter a valid phone number.

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Please provide the Contact Info for three references

We will contact them my phone and/or email

Reference 1
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.

Reference 2
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.

Reference 3
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.

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EDUCATION

*For employment our minimum education requirement is either a GED or High School diploma.
Please select the highest grade completed:

Grade School: 6. 7, 8High School: 9, 10, 11, 12College/VoTech/University
School Attendence Info

If Applicable
High School Information
Vocational / Technical School
College / University

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SECURITY
**Please be sure to complete the attached Authorization to do a criminal background check. As a condition of employment, all employees must be “Bondable” &“Insurable”.
Are you at least 18 years of Age
List States and countries of residence for the past seven years
Have you had any moving traffic violations?
If Yes, Please explain.
Have you been charged/convicted of a felony and/or misdemeanor/or served time?
If Yes, Please list (Add as many as needed)
Have you ever been charged as a perpetrator or appeared on any child abuse registry in the last 5yrs?
If yes, Please explain

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Sign and Submit
CERTIFICATION AND RELEASE: I certify that I have read and understand the applicant note on page one (1) of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions, or misrepresentations of facts In this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history. I authorize all persons, schools, companies, and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I release this company from any liability which might result from making such investigations.

I also understand that the use of illegal drugs is prohibited during employment. I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment. I understand that this application is not a contract of employment. My employment is contingent upon confirmation of credentials and successful completion of a drug test or criminal background check. I also understand that if hired, regardless of any oral presentations to the contrary, the employment relationship between Splendid Care Assisted Living and myself is terminable at will, so that both the company and I remain free to choose to end our work relationship at any time for any or no reason. Any changes in this employment relationship must be made in writing. My signature below acknowledges that I have read, understand, and agree to the above disclosure. I also understand that due to the nature of the business, no amount of work can be guaranteed.
APPLICANT SIGNATURE

Clear
DATE

MonthDayYear
Date
Thank you for filing out your Application for Splendid Care Assisted Living.

You are required to Upload Documents and complete the Attestation of Compliance PDF before your application is complete. By doing it now, information that is common to all Forms will be auto filled should you choose to continue now.
What would you like do after you submit this application?

Redirect me to the ATTESTATION OF COMPLIANCE PDF nextRedirect me to the Document Upload Form nextI will complete the application process later, by visiting the "Employment" section of https://www.splendidcarealf.com

Should be Empty:

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Monday
Tuesday
Wednesday
Thursday
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Sunday

Application Begin

Addresses (Current and Previous)

Additional Points of Contact/Emergency Contact Info

Social Media Info (Optional)

Emergency Contact Info

Please provide the Contact Info for three references

Transportation

License Info

Vehicle Info

Insurance Info

General Questions

Availability

Please complete all areas of availability:

EDUCATION

School Attendence Info

WORK HISTORY

MOST RECENT EMPLOYER

SECOND MOST RECENT EMPLOYER

THIRD MOST RECENT EMPLOYER

Thank you for filing out your Application for Splendid Care Assisted Living.