Type of Work Desired
List current (or most recent) employer first and all others in reverse chronological order. Use space at the bottom to account for all time spent unemployed or in the U.S. Armed Forces.
List three references who are not relatives or former employers
I understand that emergency conditions may require me to temporarily work shifts other than the one for which I am applying and agree to such scheduling change as directed by my department head or administrator of this institution.
This institution does not discriminate in hiring or any other decision on the basis of race, color, sex, citizenship, national origin, ancestry, or on the basis of age or physical or mental disability unrelated to ability to perform work required. No question on this applications is intended to secure information used for such discrimination.
Tieszen Memorial Home may obtain information about you from a third party consumer reporting agency from employment purposes. Thus, you may be the subject of a "consumer report" and/or an "investigative consumer report" which may include information about your character, general reputation, personal characteristics, and/ or mode of living, and which can involve personal interviews with sources such as your neighbors friends, or associates. These reports may contain information regarding your criminal history, social security verification, motor vehicle records ("driving records"), verification of your education or employment history, or other background checks.
I voluntarily give this institution the right to make a thorough investigation of my past employment and activities, agree to cooperate in such investigation and released from all liability or responsibility all person, companies or corporations supplying such information. I consent to take the pre-employment physical examination, and such future physical examinations as may be required by this institution at such times and places as the institution shall designate.
I understand that my employment is at will, and that either party is free to terminate the employment relationship at any time without cause. I also understand that my employment may be terminated for any misstatement or omission of fact appearing on this application form.
If employed, I will be required to complete an Employment Verification Form (I-9), and within three days show satisfactory evidence of identity and eligibility for employment.
Thank you for your application. We will review it and contact you shortly. Good luck!
