Dakota Estates

Dakota Estates Application For Employment

Dakota Estates Retirement Center does not discriminate on the basis of Race, Color, Creed, Religion, Sex, National origin, Age, Familial Status or Handicap.
Full Name*

First NameMiddle NameLast Name
Date of Birth*

DayMonthYear
Social Security Number*
Current Address*

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
Email Address*
example@example.com
Phone Number*
Applying for Position*
Desired start date

DayMonthYear
Desired Salary

Previous employment

Please use this section to provide information about your previous employment starting with your current or most recent job.
Employment details*

CompanySupervisorPhone numberEmailJob title
Company Address

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
Employment start date*

MonthDayYear
Employment end date*

MonthDayYear
Responsibilities*
Reason for leaving*
Employment details*

CompanySupervisorPhone numberEmailJob title
Company Address

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
Employment details*

CompanySupervisorPhone numberEmailJob title
Company Address

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
Employment start date*

MonthDayYear
Employment end date*

MonthDayYear
Responsibilities*
Reason for leaving*
Education

Please use this section to provide information about your previous education including the qualifications/certificates your have gained.
High School/College*

School nameStart dateFinish date
Address

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
University*

School nameStart dateFinish date
Address

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
Have you been convicted of a crime in the past ten years, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by a court? *

YesNo
If you have answered YES to any of the question above, please give further details.
Describe any specialized training, skill, or other qualifications:
The Information provided in this Application for Employment is true, correct, and complete. If employed, any missatement or omission of fact on this application may result in my dismissal. I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future.*

I agree
EQUAL OPPORTUNITY MONITORING FORM
Would you describe yourself to have any disability?

Blind/Partially sightedDeafDyslexiaWheelchair useOther mobility problemsUnseen disability
Other form of disability. Please specify
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Dakota Estates Application For Employment