APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT
Open Arms Care Corporation is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, veteran status, or sexual orientation.
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Name

First NameLast Name
Email
example@example.com
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Previous Address (1)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
MonthDayYear
2 digit month, 2 digit day, 4 digit yearFrom
MonthDayYear
2 digit month, 2 digit day, 4 digit yearTo
Previous Address (2)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
MonthDayYear
2 digit month, 2 digit day, 4 digit yearFrom
MonthDayYear
2 digit month, 2 digit day, 4 digit yearTo
Position Applying For

Other
Prefer
Desired Salary
Location
General Information
Days Available for Work (check all that apply):
Shift Preference
Are you currently employed?
If yes, may we contact your previous employer?
Do you have a relative currently employed by OAC?
If yes, what relationship and location?
Are you 18 years of age or older?
Have you ever been convicted of a crime?
Are you legally eligible to work in the United States?
Referred by:
In order to check your work or education record, please list any other name, assumed name, or nickname you have used.
Employment History
Employer:
Beginning with most recent
Job Title:
Street Address:
City, State, Zip:
Phone:
Supervisor:
Supervisor's Title:
May we contact?
MonthDayYear
2 digit month, 2 digit day, 4 digit yearFrom
MonthDayYear
2 digit month, 2 digit day, 4 digit yearTo
Starting Pay:
Final Pay:
Description of Duties:
Reason for Leaving:
Employer:
Job Title:
Street Address:
City, State, Zip:
Phone:
Supervisor:
Supervisor's Title:
May we contact?
MonthDayYear
2 digit month, 2 digit day, 4 digit yearFrom
MonthDayYear
2 digit month, 2 digit day, 4 digit yearTo
Starting Pay:
Final Pay:
Description of Duties:
Reason for Leaving:
Employer:
Job Title:
Street Address:
City, State, Zip:
Phone:
Supervisor:
Supervisor's Title:
May we contact?
MonthDayYear
2 digit month, 2 digit day, 4 digit yearFrom
MonthDayYear
2 digit month, 2 digit day, 4 digit yearTo
Starting Pay:
Final Pay:
Description of Duties:
Reason for Leaving:
Education and Training Information
High School Name:
Street Address:
City, State, Zip:
Diploma?
Graduation Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
GED?
College/University/Vocational Institution Name:
Street Address:
City, State, Zip:
Major:
Dates Attended

MonthDayYear
2 digit month, 2 digit day, 4 digit yearFrom
MonthDayYear
2 digit month, 2 digit day, 4 digit yearTo
Graduation Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Degree Received:
Professional License
Type of License Held:
State:
License Number:
Expiration Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Type of License Held:
State:
License Number:
Expiration Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit year
References
First and Last Name:
Street Address:
City, State, Zip:
Phone:
Business:
Years Known:
First and Last Name:
Street Address:
City, State, Zip:
Phone:
Business:
Years Known:
First and Last Name:
Street Address:
City, State, Zip:
Phone:
Business:
Years Known:
Applicant's Certification and Agreement
I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize Open Arms Care Corporation to verify the accuracy and to obtain reference information on my work performance.

I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal. The consideration of employment with OAC, I agree to comply with all the policies, procedures and requirements of OAC and applicable federal, state and local laws. However, I further understand that neither the policies, rules, regulations of employment nor anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration is at will and that either I or the Employer may terminate my employment at any time with or without notice or cause.
Electronic Signature:
By typing your name in the Electronic Signature box, you are signing this Application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Application. In addition, if I have uploaded references, or have provided them per this electronic application, I give my consent for Open Arms Care Corporation to check the personal references provided.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Should be Empty:

APPLICATION FOR EMPLOYMENT

General Information

Employment History

Education and Training Information

Professional License

References