Adam Jade Ventures Employment Application

Adam Jade Ventures Employment Application

Legacy Care Home, The Watkins House, Arlington Place, and Serenity Village
Adam Jade Ventures, Inc does not discriminate in hiring or employment on the basis of race, color, religion, national origin, age, sex, disability, sexual orientation, Vietnam era military service, or any other basis on which discrimination is prohibited by federal, state, or local laws.
Location Applying For*
Full Name*

First NameLast Name
Present Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Permanent Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Email Address*
YesNo
Position Desired*
Date Available to Work*

MonthDayYear
Salary Desired
YesNo
YesNo
YesNo
If yes, where and when?
YesNo
How were you referred?
If referred by employee, please provide their name
High School/GED - Name and Location
High School - Years Attended
YesNo
College - Name and Location
College - Years Attended
YesNoN/A
College - Subjects Studied
Trade/Business/Correspondence School - Name and Location
List any licenses, awards, certifications, or registrations pertinent to your application
List your last four employers, starting with the most recent.
Employer 1 - Company Name, Address, Phone
Employer 1 - Position, Dates (From/To), Supervisor, Salary, Reason for Leaving
Employer 2 - Company Name, Address, Phone
Employer 2 - Position, Dates (From/To), Supervisor, Salary, Reason for Leaving
Employer 3 - Company Name, Address, Phone
Employer 3 - Position, Dates (From/To), Supervisor, Salary, Reason for Leaving
Employer 4 - Company Name, Address, Phone
Employer 4 - Position, Dates (From/To), Supervisor, Salary, Reason for Leaving
Please provide 3 professional references.
Reference 1 - Name, Title, Company, Phone
Reference 2 - Name, Title, Company, Phone
Reference 3 - Name, Title, Company, Phone
Please list any other job-related information you think would be helpful (work experience, volunteer activities, hobbies, clubs, professional organizations, publications, accomplishments, etc.)
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By signing below, I certify that the information provided is true and correct. I understand that misrepresentation may be cause for termination. I authorize Adam Jade Ventures, Inc to verify any information and contact former employers.
Applicant Signature*

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