Employment Application

Employment Application

Applicant Information

Best time to contact you at home is… (AM)
Best time to contact you at home is… (PM)

Additional Information

Do any of your friends or relatives work for Care Connection?
Do any of your relatives currently serve on any Center Services Board?
Are you currently employed?
Have you ever been involuntary terminated or resigned in lieu of termination?
(Proof of citizenship or immigration status will be required upon employment)
Are you a veteran?
Are you available to work ….
Are you currently on lay-off status and subject to recall?
Can you travel to training and other out of town meetings?
Are you an insured motorist?

We Are An Equal Opportunity Employer

Gender

High School Education

Undergraduate

Graduate

Other

Work Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, age, religion, gender, national origin, disabilities or other protected status. Up to three work references can be listed.

Work Experience 2 (Optional)

Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, age, religion, gender, national origin, disabilities or other protected status. Up to three work references can be listed.

Work Experience 3 (Optional)

Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, age, religion, gender, national origin, disabilities or other protected status. Up to three work references can be listed.
You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability, or other protected status.
Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given.

Reference

Personal/Professional References (Do not include family members or past supervisors) Please include at least two professional references.
As evidenced by my signature below I understand and agree to the following:


A health certificate from a physician may be required at a later time if you are hired.


Proof of employment eligibility status will be required.


Employment is at the will of Care Connection. Employment may be terminated at any time with proper notification by either party.


Care Connection is an Equal Opportunity Employer. Care Connection does not discriminate on the basis of sex, race, national origin, creed, age, martial status or disability in its programs, services or employment practices.

Code of Ethics
• Care Connection For Aging Services personnel will exhibit the highest ethical standards and personal integrity.
• Care Connection For Aging Services personnel will provide a professional work environment that is free from physical, psychological, written, or verbal intimidation or harassment.
• Care Connection for Aging Services will not physically, sexually, or emotionally abuse or neglect a minor or adult.
• Care Connection For Aging Services will share concerns about suspicious or inappropriate behavior with their supervisor or administrator.
• Care Connection For Aging Services will report any suspected abuse or neglect of a minor or adult to the state authorities.
• Care Connection For Aging Services will accept their personal responsibility to protect minors and adults from all forma of abuse.

I hereby authorize Care Connection to obtain information pertaining to any charges and/or convictions I may have had for federal and state criminal law violations. This information will include but not be limited to allegations and convictions for crimes committed upon minors and will be gathered from any law-enforcement agency of this state or any state or federal government, to the extent permitted by state and federal law.

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

Your privacy matters to us. Please take a moment to review our privacy policy to understand how we collect, use, and protect your personal information.

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