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  • NAZCARE, Inc Application for Employment

    An Equal Opportunity Employer

  • Employees of NAZCARE and applicants for employment shall be afforded equal opportunity in all aspects of employment without regard to race, color, religion, political affiliation, national origin, disability, marital status, gender or age. 

    As a means of accommodation to persons with specific disabilities that prevent them from completing this application, confidential assistance in filling out this application may be obtained.

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Education:

  • Highest Grade Completed (Secondary Education):*
  • If you did not complete high school, do you have a high school equivalency diploma or GED?
  • Select the number of years of post high school education:
  • Date Completed or Graduation Date:
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  • Experience and Employment, Volunteering History

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    10. EXPERIENCE - Use Supplementary Experience Form(s) for additional space.

     

    Starting with the most recent, describe ALL paid, military and applicable voluntary experience. Highlight your knowledge, skills and abilities which best demonstrate your qualifications for this position You may list significantly different jobs within the same organization as separate items

  • May we contact your present supervisor?*

  • Job #1:

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  • Job #2:

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  • Job #3:

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  • Employment Information - Continued:

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  • References

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    • Miscellaneous: 
    • Check which shift you will accept:*
    • Check which job status you would accept:*
    • Check which employment status you would accept:
    • Are you willing to accept employment which requires you to travel?
    • Are you willing to provide your own transportation if necessary for your employment?
    • May we contact your former employers?*
    • For purposes of compliance with The Immigration Reform and Control Act, are you legally eligible for employment in the United States? Under the Immigration Reform and Control Act of 1986, you will be required to fill out a certification verifying that you are eligible to be employed and verifying your identity. Further, you will be required to provide documentation to that effect should you be employed.
    • Are you a U.S. Military Service Veteran?
    • If yes, were you discharged honorably?
    • Have you ever been convicted for any violation(s) of law, including moving traffic violations?*
    • Voluntary Information:  

    • Voluntary Information:

      Pursuant to Federal Regulations, we collect responses to the questions below for record keeping purposes. This information will NOT be kept with your application for employment. Federal law prohibits unlawful discrimination on the basis of race, color, sex, age, national origin, religion, or disability. This information is provided by you on a completely voluntary basis, and is not a requirement nor shall hold any bearing on employment consideration
    • Check the block for the racial or ethnic group with which you identify (voluntary):
    • Check the block for the highest level of education you have completed (check only one, voluntary):
    • Check the appropriate block (voluntary):
    • Date of Birth (voluntary)
       / /
    • Disability: I do have a disability or I do not have a disability* (*"Disability" means, with respect to an individual: a physical or mental impairment that substantially limits one or more of the major life activities of such individual; a record of such an impairment; or being regarded as having such an impairment.)
    • Acknowledgement: 

    • Acknowledgement:

    • NOTE: All employment relationships with NAZCARE are of an at-will nature. This means that should you become employed, you may resign at any time, or NAZCARE may terminate you at any time. with or without cause. subject to Federal and State statutory limitations.

      14.CERTIFICATION--Each Application Requires Current Date and Original Signature I hereby certify that all entries on both sides and attachments are true and complete, and 1agree and understand that any falsification of information herein, regardless of time of discovery. may cause forfeiture on my part to any employment in the service of the NAZCARE 1 understand that all information on this application is subjectto verification and consent to criminal history background checks. I also consent to references and former employers and educational institutions listed being contacted regarding this application. I further authorize NAZCARE to rely upon and use. as it soes fit. any information received from such contacts. Information contained on this application may be disseminated to other agencies, nongovernmental organizations or systems on a need to know basis for good cause shown as determined by the CEO designee.

    • Date*
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    • Should be Empty: