Employment Application - Bridges Senior Lifestyle Living

Name(Required)

First Middle Last

How did you hear about us?

Other Source

Your Phone

Your Email(Required)

Your Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Which position are you applying for?

Please fill in the position you are applying for

Availability

Days

Evenings

Capacity

Part-time

Full-time

Have you ever filed an application with us before?

Yes

Yes, Dates

Have you ever been employed with us before?

Yes

Yes, Dates

Can you travel if a job requires it?

Yes

May we contact your current employer?

Yes

Have you ever had any job related training in the United States Military?

Yes

Yes, Explain

Are you capable of performing the essential functions of this position?

Yes

Indicate any foreign languages you can speak, read and/or write.

References (Cannot be related to you or a previous employer.)

Reference - 1

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Reference - 2

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Reference - 3

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Education: High School

Name

Location

Diploma/Degree

Training/Honors/Etc.

Check all years completed.

Education: Trade School

Name

Location

Diploma/Degree

Training/Honors/Etc.

Check all years completed.

Education: College/University

Name

Diploma/Degree

Training/Honors/Etc.

Check all years completed.

Education: Additional Schooling

Location

Diploma/Degree

Training/Honors/Etc.

Check all years completed.

Employment 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, religion, gender, national origin, handicap or other protected status.

Employment - 1

Employer Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Job Title

Supervisor

Reason for Leaving

Date Began

MM slash DD slash YYYY

Date Ended

MM slash DD slash YYYY

Starting Rate

Final Rate

Work Performed/Responsibilities:

Employment - 2

Employer Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Job Title

Supervisor

Reason for Leaving

Date Began

MM slash DD slash YYYY

Date Ended

MM slash DD slash YYYY

Starting Rate

Final Rate

Work Performed/Responsibilities:

Employment - 3

Employer Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Job Title

Supervisor

Reason for Leaving

Date Began

MM slash DD slash YYYY

Date Ended

MM slash DD slash YYYY

Starting Rate

Final Rate

Work Performed/Responsibilities:

Special Skills and Qualifications

Summarize special job-related skills and qualifications acquired from employment or other experiences.

If you were unemployed at any time since leaving school, please indicate what you were doing during this time.

Upload Resume

Accepted file types: pdf, doc, docx, jpg, jpeg, Max. file size: 256 MB.

Acceptable File Formats: pdf, doc, docx, jpg, jpeg

Applicant's Statement & Agreement

By submitting this application, I hereby authorize the employers listed above to release all information to Bridges Senior Lifestyle Living. I also understand that this authorization is valid for 60 days. I waive any liability to the employers listed above, and its employees, from any claims of action for disclosure of information that could adversely affect any new employment opportunity.

I certify that the above information is true and correct and give authorization for investigation of all statements and information contained in this application, my resume, and other documents or verbally obtained information obtained during an employment interview. I voluntarily consent to allow Bridges Senior Lifestyle Living, or any of their representatives or agents to check my references by contacting any persons, company or governmental entity they deem to be an appropriate reference. I understand that references questions may pertain to my personal or educational background, work experiences, character and behavior. I understand my employment is subject to satisfactory verification of this information and agree that deliberate falsification of this document or significant omissions shall be grounds for employment consideration disqualification or dismissal from employment, if discovered at a later date. I pledge, if hired, to comply with the guidelines of conduct and company policies and procedures of Bridges Senior Lifestyle Living. I also realize that company policies, procedures, practices or statements made during an interview or employment do not create an employment contract by implication or otherwise. I further understand and agree that my employment is for no definite period of time and may, regardless of time and manner, be terminated by the company or myself with or without cause or previous notice. I understand that employment may be subject to satisfactory completion of physical examination and/or drug screening.