FAIRWOOD ASSISTED LIVING APPLICATION FOR EMPLOYMENT

FAIRWOOD ASSISTED LIVING APPLICATION FOR EMPLOYMENT
Date*

MonthDayYear
Date
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Position Desired*
Have you ever applied for employment with us?*

YesNo
Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of work desired:*

Full TimePart TimeOn CallOvertime
Are you legally eligible for employment in the United States?*

YesNoNot sure
When will you be available to work?*
Other other specialty training or skills? (Languages, credentials, etc)*
EDUCATION:
Education level: (Check if completed)*

HighschoolTrade School/ TechnicalCollegeGraduate
EMPLOYMENT EXPERIENCE:
Have you ever been terminated or asked to leave a previous position?*

YesNo
Employer #1):   Employer Name*           Address:    Employer Address*

Dates Employed From    Start Date*      to End Date*

Job Title:   Job Title*

Supervisor Name:   First Name*   Last Name*

Supervisor Telephone Number:   Area Code*   Phone Number*

Reason for Leaving:   Reason for Leaving*

Rate of Pay Starting:   Starting Pay*   Ending   Ending Pay*
Employer #2):   Type a label           Address:    Type a label

Dates Employed From    Date      to Date

Job Title:   Type a label

Supervisor Name:   First Name   Last Name

Supervisor Telephone Number:   Area Code   Phone Number

Reason for Leaving:   Type a label

Rate of Pay Starting:   Type a label   Ending   Type a label
Employer #3):   Type a label           Address:    Type a label

Dates Employed From    Date      to Date

Job Title:   Type a label

Supervisor Name:   First Name   Last Name

Supervisor Telephone Number:   Area Code   Phone Number

Reason for Leaving:   Type a label

Rate of Pay Starting:   Type a label   Ending   Type a label
REFERENCES
Reference Name: Name*

Reference Telephone Number: Area Code* Phone Number*
Reference Name: Name*

Reference Telephone Number: Area Code* Phone Number*
Reference Name: Name*

Reference Telephone Number: Area Code* Phone Number*
BACKGROUND CHECK AUTHORIZATION FORM

Applicants, visit the website: https://fortress.wa.gov/dshs/bcs/ 1) Please go to the above website to open the online Background Check Authorization form. 2) Help tools incorporated into form Click on ? icons. BCS Online Authorization Form Guide 3) After signing and saving Background Check Authorization form, the system will generate a confirmation code. You will NOT be able to retrieve the confirmation code after closing/ exiting the page. 4) Provide confirmation code and date of birth to the entity requesting your background check. You can provide confirmation code and your date of birth
Confirmation Code:*
Please Contact Human Resources with your confirmation code and date of birth. (509) 468-0457 Ext: 0 Humanresources@fairwoodretirement.com
Birth Date*

MonthDayYear
Date
Should be Empty:

FAIRWOOD ASSISTED LIVING APPLICATION FOR EMPLOYMENT

EDUCATION:

EMPLOYMENT EXPERIENCE:

REFERENCES

BACKGROUND CHECK AUTHORIZATION FORM