• EMPLOYMENT APPLICATION Camilla Hall Nursing Home
  • Camilla Hall is an equal opportunity employer and affords equal opportunity to all applicants for all positions without regard to race, color, religion, gender, national origin, age, disability, veteran status or any other status protected under local, state or federal laws.
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  • Days & hours you are available:
  • EDUCATION
  • EMPLOYMENT HISTORY (Please begin with current or most recent employer)
  • Employer 1
  • Employer 2
  • Employer 3
  • Employer 4
  • REFERENCES (Please list three persons who are not related to you, or previous supervisors who can provide professional references.)
  • Reference 1
  • Reference 2
  • Reference 3
  • Applicant Acknowledgement and Authorization Please Read Carefully Before Signing   I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery.   I understand that submission of an application does not guarantee employment. I further understand that, should an offer of employment be extended by Camilla Hall, such employment is at will, for no specified duration and may be terminated by either Camilla Hall or myself at any time, with or without cause of notice. I understand that none of the documents, policies, procedures, actions, statements of Camilla Hall or its representatives used during the employment process is deemed a contract of employment real or implied.   I understand that no representative of Camilla Hall, except the Administrator, has the authority to enter into any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements and that any such agreements must be made in writing and signed by the Administrator of Camilla Hall.   In consideration for employment with Camilla Hall, if employed, I agree to conform to the rules, regulations, policies and procedures of Camilla Hall at all times and understand that such obedience is a condition of employment. I understand that due to the nature of Camilla Hall business, attendance and punctuality are considered essential requirements of every job and that poor attendance or tardiness will result in disciplinary action.   I understand that if offered a position with Camilla Hall, I may be required to submit to a pre-employment medical examination, drug screening and background check as a condition of employment. I understand that unsatisfactory results from refusal to cooperate with, or any attempt to affect the results of these pre-employment tests and checks will result in withdrawal of any employment offer or termination of employment if already employed.   I hereby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to Camilla Hall and/or any of its representatives, agents or vendors and I release all parties involved from any and all liability for any and all damage that may result from providing such information.   I understand that this application is considered current for six months. If I wish to be considered for employment after this period, I must fill out and submit a new application.   BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREED TO THE ABOVE STATEMENTS.
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  • Camilla Hall Nursing Home
  • Confidential Employment Reference Request A copy of this form will be sent for completion to your current/former employer for personal/professional references.
  • APPLICANT AUTHORIZATION : I hereby give permission for the release of all requested information to Camilla Hall Nursing Home. I hereby release all parties and/or organizations from any and all liability associated with the release of this information. I understand that any information obtained will be kept confidential and I waive any rights to access such information.
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  • Applicant: Do not type below.

  • The above named applicant has indicated that he/she was previously or is still employed by you. Your evaluation of this applicant is greatly appreciated and will be held in complete confidence.
  • Please check one of the following for each characteristic that best describes the applicant
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    Job Knowledge
    Quality of Work
    Attendance
    Punctuality
    Cooperation
    Initiative
    Attitude
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  • Should be Empty: