APPLICATION FOR EMPLOYMENT

We consider applicants for all position without regard to race, color, religion, creed, gender, national origin, age, disability, marital status, or any other legally protected status.

Please complete entire application. Incomplete applications will not be reviewed.

Position applied for is required.
Please provide a valid date of application.
Last Name is required.
First Name is required.
Middle is required.
Address is required.
City is required.
Zip Code is required.
Telephone Number is required.
Home Number is required.
Cell Number is required.
Please provide a valid email address.
When is the best time to contact you? is required.
Please select an option.
When? is required.
Where is required.
Please select an option.
When? is required.
Where is required.
Please state their name, relationship, and location is required.
Please select an option.
Please select an option.
Name of supervisor is required.
Please select an option.
Proof of citizenship or immigration status will be required upon employment is required.
Please provide a valid date available to work?.
Desired salary range? is required.
Please select an option.
Please select an option.

Work Availability: Please indicate all hours of availability for each day of the week.

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Education

School Name and Address of School Course Of Study Years Completed Diploma or Degree
High School
Undergraduate College
Graduate/Professional
Other (Specify)

Employment History

Employment Experience Start with your current or most recent job. Include any military service and volunteer activities.

Employment #1
Employer is required.
Address is required.
Telephone Number is required.
Starting/Present Job Title is required.
Please provide a valid date employed from.
Please provide a valid date employed to.
Hourly Rate / Salary is required.
Starting is required.
Final is required.
Work Performed is required.
Reason for Leaving is required.
Please select an option.

References

Name Phone Number Best Time to Call Occupation / Relationship

Note to applicants: Do not answer this question unless you aware of the requirements of the job that you are applying for.

Please select an option.

Applicants Statement:

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at any employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand also, that I am required to abide by all rules and regulations of the Employer.

Applicant’s Name is required.
Please provide a valid date.
Please select an option.

I, (print) authorize MAPLE LEAF HOME CARE LLC to make any inquiries it deems necessary in connection with my application for employment or in the course of review of any employment. I authorize all persons, schools, companies, corporations, credit bureaus, department of motor vehicles and law enforcement agencies to supply information concerning my background. I release all persons who provide information to MAPLE LEAF HOME CARE LLC concerning me, from all liability or any damages on account of inquiry into and the furnishing of said information.

A photocopy of this authorization shall be deemed and original and shall be accepted as such by every person. As per the Fair Credit Reporting Act, I am entitled to know if employment is denied because of information obtained from a consumer-reporting agency.

Applicant Signature

Clear Signature

Draw your signature above
Date is required.
Instructions:
• Use your mouse or finger to sign
• Sign clearly within the box
• Click "Clear" to start over
Maiden/Other Names Used is required.
Social Security Number is required.
Name as It Appears on Driver’s License is required.
Driver’s License# is required.
State is required.
Current Address is required.
City is required.
Zip Code is required.
Phone# is required.
Please provide a valid date of birth.
Place of Birth is required.
Race is required.
Sex is required.
You must agree to the privacy policy before submitting.

Select a country first.