Employment Application
Complete each field, sign and submit.
SECTION 1- POSITION, PERSONAL & DRIVER INFORMATION
Position Applying For:
Employment Type:
Full-Time
Part-Time
PRN
Date Available:
-
Month
-
Day
Year
Date
Full Legal Name:
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
City:
State:
Zip Code:
Valid Driver's License:
Yes
No
License #:
State:
Expiration:
Auto Insurance:
SECTION 2- EMPLOYMENT HISTORY
Employer #1:
Position:
Dates:
Supervisor Name & Phone:
Reason for Leaving:
Employer #2:
Position:
Dates:
Supervisor Name & Phone:
Reason for Leaving:
Employer #3:
Position:
Dates:
Supervisor Name & Phone:
Reason for Leaving:
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SECTION 3- AVAILABILITY
Days Available:
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Preferred Shift:
Morning
Afternoon
Evening
Overnight
Live-In
Counties Willing to Work In:
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SECTION 4 - CRIMINAL DISCLOSURE & EMPLOYMENT CONDITIONS
Have you ever been convicted of, pled guilty to, or pled no contest to a criminal offense (excluding minor traffic violations)?
Yes
No
If yes, please explain (include date and jurisdiction):
Answering "Yes" does not automatically disqualify you from employment. Each situation will be reviewed individually.
I understand that any offer of employment is contingent upon successful completion of required background screening, drug testing, credential verification (if applicable), and health screening.
Employment At-Will Notice
If hired, employment with Comerstone Care Services is at-will. This means that either the employee or the company may terminate employment at any time, with or without cause or notice, subject to applicable law.
SECTION 5 - EQUAL EMPLOYMENT OPPORTUNITY
Equal Employment Opportunity Statement
Cornerstone Care Services of the Carolinas provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, pregnancy, national origin, age, disability, genetic information, veteran status, or any other protected classification under federal or state law.
Employment decisions are based solely on qualifications, experience, and business needs.
SECTION 6 - APPLICANT CERTIFICATION
I certify that the information in this application is true and complete. I understand that providing false or incomplete information may result in withdrawal of an employment offer or termination of employment.
Applicant Signature (Type Full Name):
Date:
-
Month
-
Day
Year
Date
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