Office Admin Application

Office Admin Application

The completion of this application form is part of stage one. This application will be reviewed, and a decision made as to whether to proceed to stage two, the interview, based on this information. About Family Healthcare is an EQUAL OPPORTUNITY EMPLOYER.
Today's Date

MonthDayYear
Date
Full Name*

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth *

MonthDayYear
Position Applying For:

Office ManagerOffice AssistantHuman Resources ManagerHuman Resources Assistant
How did you hear about About Family Healthcare?
Education*
Training History/Professional Status - Please list any registrations/licenses/certifications that you presently have and status (i.e. current, suspended, revoked, etc.)
Please upload copies of your certificates (if applicable)

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List additional qualifications, skills and knowledge of equipment you may have to assist you with in-the Office Manager position.
Details of past employment starting with the most recent. At least 5 years of work history must be provided.*
May we contact employer (s) listed?*

YesNo
Are you eligible to work in the U.S.?

YesNo
Are you available to work 9a - 4p, Monday - Friday?*
Are you available 1-2 Saturday's per month for an audit support?*
Rate of Pay Expected Per Hour?*
Date Available to Work*

MonthDayYear
Date
Do you have the following?*

CPR CertificationFirst Aid
Think of the WORST supervisor you have ever had, what characteristics made that person a poor manager?
Imagine you have been on your feet and working hard all day. A customer that you have been dealing with is rude and impatient, what do you do?
List the name, relationship, number of years acquainted, and phone number of 3 references. (No relatives please).*
Record of conviction does not necessarily disqualify an applicant from employment considerations.
Have you ever been convicted of, or plead guilty to, found guilty of, and/or plead to a felony or misdemeanor, except for a minor traffic violation?*

YesNo
If so, when, where, and disposition of offense? (Type N/A if not applicable)
Have you ever been charged with a crime that has not yet resulted in a plea of guilty, court trial, deferred adjudication or dropping of the charge?*

YesNo
Please declare all criminal convictions, whether spent or not, charges, whether proceeded with or not and warnings and cautions in the space provided below. (Type N/A if not applicable)
Do you have your own transportation?*

YesNo
Driving License that is valid?*

YesNo
Valid Texas required car insurance?*

YesNo
Do you consent to pre-employment background/criminal record check (including all open and closed records)?*

YesNo
Emergency Contact*
Resume*

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Cover Letter (Preferred)

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Confidentiality Statement

We consider it an essential practice to uphold the confidentiality of your personal information. We do not allow third parties to gain access to your personal information without your consent. Information that is collected through online forms will be kept confidential.
SIGNATURE and DECLARATION

I certify that all the information I have provided is true, complete and correct.

The information contained within this application or any cover letter or resume attached is not shared with any third parties. The information is used by the employer only as an aid in the hiring decision making process. The applicant, by signing the application gives the employer consent to collect the information contained herein and use for the purpose specified.

While management strives to accommodate individual preferences, business needs may require mandatory conditions such as overtime, shift work, rotating schedules, or non-traditional workdays. I understand and accept these conditions as part of my ongoing employment.

I authorize this company to investigate all statements contained on this application. I understand that any misrepresentation or omission of facts called for is cause for immediate disqualification and/or if employed, immediate dismissal.

I understand that if I am hired, I will be required to provide criminal background check at my cost, proof of identity and legal authority to work in the United States, proof of certifications or educational qualifications, and a drivers abstract (if applicable).

Furthermore, I understand and agree that if employed, I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same rights to terminate my employment at any time, with or without prior notice, except as may be required by law. This application does not in any way constitute an agreement or contract for employment.
Date*

MonthDayYear
Date
Signature
Please verify that you are human*
Data Protection Statement The personal information (data) collected on this form, are used only for the purpose of this employment. Equality of Opportunity Statement The Agency’s Equal Opportunities Policy covers all employees, or potential employees, and embraces the principle that all people shall be treated equally, regardless of their age, gender, ethnic origin, nationality, colour, religion, marital status, sexual orientation, religion or belief, disability, or offending background.
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