JOIN THE TEAM AT ADORABLE SENIOR LIVING!

Adorable Senior Living is looking for compassionate and friendly caregivers to join our team. Our caregivers provide care services for our seniors, as well as daily activities and companionship. If you are interested in applying, please fill out the form below.

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT

DATE OF APPLICATION

FIRST NAME

LAST NAME

MIDDLE NAME

ADDRESS (STREET NUMBER AND NAME)

CITY

DATE OF BIRTH

STATE

ZIP CODE

PHONE (HOME OR WHERE YOU CAN BE REACHED)

BUSINESS PHONE

AVAILABILITY

ARE YOU CURRENTLY EMPLOYED?

Yes

ARE YOU RELATED BY BLOOD OR MARRIAGE TO ANY PERSON NOW WORKING FOR ADORABLE SENIOR LIVING?

Yes

IF SUBJECT TO MILITARY SELECTIVE SERVICE REGISTRATION, CERTIFY COMPLIANCE

CHECK THE TYPES OF WORK YOU WILL ACCEPT

Permanent Full-Time

Permanent Part-Time

Temporary Full-Time

Temporary Part-Time

Any of the Preceding

Work Involving Travel

IF YOU ARE NOT AVAILABLE FOR WORK NOW, ENTER THE EARLIEST DATE YOU COULD BEGIN TO WORK

LIST HOURS OF AVAILABILITY

WILL YOU ACCEPT WORK ANYWHERE IN WAKE, CUMBERLAND, AND HARNETT COUNTRY?

Yes

JOBS APPLIED FOR

ENTER BELOW THE SPECIFIC TITLE(S) OF THE JOB(S) FOR WHICH YOU ARE APPLYING (I.E. LP, QP, AP, PP, CERTIFIED PEER SPECIALIST)

REFERRAL SOURCE

REFERRAL SOURCE

PLEASE INDICATE YOUR REFERRAL SOURCE

IF YOU WERE REFERRED BY THE EMPLOYMENT SECURITY COMMISSION (JOB SERVICE) PLEASE INDICATE WHICH LOCAL OFFICE

ARE YOU LEGALLY ELIGIBLE TO BE EMPLOYED IN THE UNITED STATES?

Yes

ARE YOU OVER THE AGE OF 18 YEARS? (IF NO, YOU MAY BE REQUIRED TO PROVIDE AUTHORIZATION TO WORK)

Yes

HAVE YOU EVER WORKED UNDER ANOTHER NAME?

Yes

DO YOU HAVE A VALID DRIVER'S LICENSE?

Yes

EDUCATION

EDUCATION

COLLEGE

GRADUATE SCHOOL

UNDER SEMESTER / QUARTER HOURS, LIST THE HOURS OF CREDIT RECEIVED AND IF THEY WERE SEMESTER(S) OR QUARTER(Q) HOURS

HIGH SCHOOL

NAME

LOCATION

DATES ATTENDED

FROM

GRADUATE?

Yes

COLLEGE(S) / UNIVERSITY(S)

NAME

LOCATION

DATES ATTENDED

FROM

GRADUATE?

Yes

SEMESTER/ QUARTER HOURS

MAJOR/ MINOR COURSE WORK

TYPE OF DEGREE RECEIVED

GRADUATE OR PROFESSIONAL

NAME

LOCATION

DATES ATTENDED

FROM

GRADUATE?

Yes

SEMESTER/ QUARTER HOURS

MAJOR/ MINOR COURSE WORK

TYPE OF DEGREE RECEIVED

OTHER EDUCATIONAL, VOCATIONAL SCHOOL, INTERNSHIP, ETC.

OTHER NAME

LOCATION

DATES ATTENDED

FROM

GRADUATE?

Yes

SEMESTER/ QUARTER HOURS

MAJOR/ MINOR COURSE WORK

TYPE OF DEGREE RECEIVED

CERTIFICATIONS

CERTIFICATIONS

Check all that applies and date of certificate / training

Check all that applies and date of certificate / training

CERTIFICATIONS

CPR/First Aid Certification

Enter date here

NCI-Prevention and Core Training

Enter date here

Blood-borne Pathogen Training

Enter date here

Medication Administration Training

Enter date here

Seizure Management Training

Enter date here

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IF THE JOB(S) APPLIED FOR CALLS FOR SPECIFIC COURSES, INDICATE THOSE COURSES TAKEN AND CREDITS RECEIVED

Free Text

CURRENT PROFESSIONAL STATUS (LIST FIELDS OF WORK FOR WHICH YOU HAVE BEEN REGISTERED)

REGISTRATION

STATE

NUMBER

REGISTRATION

STATE

NUMBER

Free Text

MEMBERSHIP IN PROFESSIONAL, HONORARY, OR TECHNICAL SOCIETIES (LIST)

SKILLS

SKILLS

CHECK THE FOLLOWING SKILLS, EXPERIENCES, ETC., WHICH YOU HAVE

Car for use at work

Sign Language

Specify language here

Mental Health Services

Substance Abuse Services

Enter details here

Shorthand/Speed Writing (Specify Word Per Minute)

Enter words per minute

Counseling

Teaching/ Coaching/ Mentoring

Braille

Word Processing

New Field:

Other

Enter other here

HAVE YOU EVER BEEN CONVICTED OF AN OFFENSE AGAINST THE LAW OTHER THAN A MINOR TRAFFIC VIOLATION? (A CONVICTION DOES NOT MEAN YOU CANNOT BE HIRED. THE OFFENSE AND HOW RECENTLY YOU WERE CONVICTED WILL BE EVALUATED IN RELATION TO THE JOB FOR WHICH YOU ARE APPLYING)

Yes

ADORABLE SENIOR LIVING IS A DRUG FREE ENVIRONMENT. EMPLOYEES ARE SUBJECT TO RANDOM DRUG TESTING.

WORK HISTORY

Please include volunteer experience. As you describe your work history experiences, make sure you highlight your competencies, which demonstrates your qualifications for the position you are applying to.

CURRENT OR LAST EMPLOYER

ADDRESS

JOB TITLE

SUPERVISOR'S NAME

TELEPHONE NUMBER

NUMBER SUPERVISED BY YOU

DATE EMPLOYED

DATE SEPARATED

STARTING SALARY

ENDING OR CURRENT SALARY

MAY WE CONTACT EMPLOYER

Yes

REASON FOR LEAVING

FULL TIME

YEARS

MONTHS

PART-TIME

YEARS

MONTHS

IF PART-TIME, NUMBER OF HOURS WORKED PER WEEK

LIST MAJOR DUTIES THAT DEMONSTRATE YOUR COMPETENCIES RELATED TO THE POSITION FOR WHICH YOU ARE APPLYING IN ORDER OF THEIR IMPORTANCE IN THE JOB

Field label

EMPLOYER

ADDRESS

JOB TITLE

SUPERVISOR'S NAME

TELEPHONE NUMBER

NUMBER SUPERVISED BY YOU

DATE EMPLOYED

DATE SEPARATED

STARTING SALARY

ENDING OR CURRENT SALARY

MAY WE CONTACT EMPLOYER

Yes

REASON FOR LEAVING

FULL TIME

YEARS

MONTHS

PART-TIME

YEARS

MONTHS

IF PART-TIME, NUMBER OF HOURS WORKED PER WEEK

LIST MAJOR DUTIES THAT DEMONSTRATE YOUR COMPETENCIES RELATED TO THE POSITION FOR WHICH YOU ARE APPLYING IN ORDER OF THEIR IMPORTANCE IN THE JOB

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EMPLOYER

ADDRESS

JOB TITLE

SUPERVISOR'S NAME

TELEPHONE NUMBER

NUMBER SUPERVISED BY YOU

DATE EMPLOYED

DATE SEPARATED

STARTING SALARY

ENDING OR CURRENT SALARY

MAY WE CONTACT EMPLOYER

Yes

REASON FOR LEAVING

FULL TIME

YEARS

MONTHS

PART-TIME

YEARS

MONTHS

IF PART-TIME, NUMBER OF HOURS WORKED PER WEEK

LIST MAJOR DUTIES THAT DEMONSTRATE YOUR COMPETENCIES RELATED TO THE POSITION FOR WHICH YOU ARE APPLYING IN ORDER OF THEIR IMPORTANCE IN THE JOB

Free Text

EMPLOYER

ADDRESS

JOB TITLE

SUPERVISOR'S NAME

TELEPHONE NUMBER

NUMBER SUPERVISED BY YOU

DATE EMPLOYED

DATE SEPARATED

STARTING SALARY

ENDING OR CURRENT SALARY

MAY WE CONTACT EMPLOYER

Yes

REASON FOR LEAVING

FULL TIME

YEARS

MONTHS

PART-TIME

YEARS

MONTHS

IF PART-TIME, NUMBER OF HOURS WORKED PER WEEK

LIST MAJOR DUTIES THAT DEMONSTRATE YOUR COMPETENCIES RELATED TO THE POSITION FOR WHICH YOU ARE APPLYING IN ORDER OF THEIR IMPORTANCE IN THE JOB

REFERENCES

REFERENCES

List 3 references that we may contact; 2 must be professional references

REFERENCE

ADDRESS

JOB TITLE

RELATIONSHIP

TELEPHONE NUMBER

YEARS KNOWN

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REFERENCE

ADDRESS

JOB TITLE

RELATIONSHIP

TELEPHONE NUMBER

YEARS KNOWN

Free Text

REFERENCE

ADDRESS

JOB TITLE

RELATIONSHIP

TELEPHONE NUMBER

YEARS KNOWN

I certify that the information contained in this application is correct to the best of my knowledge and understand that falsification of this information is grounds for refusal to hire or, if hired, dismissal. I authorize any insurance company, employer, educational institution, law enforcement organization, state or federal government agency, information service bureau, medical facility or practitioner, and any other person or organizations listed in this application to release information regarding my character, performance, qualifications, background, reasons for termination of past employment, and eligibility for rehire to. I also understand that as a condition of my employment I will complete a background check including, but not limited to, criminal records, social security number verification, and driving record. I also authorize the release of my driving history and criminal records, and understand that it may contain information about my background, mode of living, character, and personal reputation. I understand that a criminal conviction is not an automatic bar from employment and will be reviewed for job related impact. I authorize you to request and receive such information, and release you and all parties involved in providing such information from any responsibility or liability. I understand that the decision to hire is solely that of Company.

As a condition of my employment with the Company, I agree that all information which I receive in the course of my employment relating in any manner to, among other things, the business activities, customers, production processes, financial affairs, programs, concepts or designs of Company are to be treated by me as trade secrets and kept in confidence, not to be disclosed to any unauthorized person either during or after my employment, or used by me in any manner adverse to the interests of Company. In addition, I may be required to sign a separate Invention and Confidentiality Agreement. In consideration for my employment by Company, I agree to conform to the rules and regulations of the Company and acknowledge that these rules and regulations may be changed, interpreted, suspended, withdrawn, or added to by Company at any time, at the Company's sole option and without any prior notice to me.

I further acknowledge that my employment is at-will and may be terminated, and any offer of employment, if such is made, or my acceptance of an employment offer, if such is to occur, may be withdrawn, with or without cause, and with or without prior notice, at any time, at the option of the company or me. I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between Company and myself for either employment or for providing of any benefit.

If my services terminate after accepting employment, I understand that Company, or any of its affiliates may supply, in confidence, my employment record to any prospective employer, with no liability to the Company or its staff. I acknowledge that I have been advised that this application will remain active for no more than sixty (60) days from the date it was made.

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NAME OF APPLICANT

DATE

AUTHORIZATION FOR BACKGROUND CHECK

AUTHORIZATION FOR BACKGROUND CHECK

(Please read and fill this form in the space provided below. Your written authorization is necessary for completion of the application process.)

Enter name here

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, hereby authorize ADORABLE SENIOR LIVING to investigate my background and qualifications for purposes of evaluating whether I am qualified for the position for which I am applying. I understand that ADORABLE SENIOR LIVING will utilize an outside firm or firms to assist it in checking such information, and I specifically authorize such and investigation by information services and outside entities of the company's choice. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application for employment will not be processed further.

EMPLOYEE'S NAME

DATE

For more information, or to schedule an appointment, call us at 919-732-4201.

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