Employment Application

RECORD OF EDUCATION
Amount of education considered necessary will vary according to the job applied for.
High School: Did you finish? If not, indicate grade completed.
Name of High School and location:
Major Subjects
College: Did you finish? If not, indicate grade completed.
Name of College and location:
Major Subjects
School of Nursing: Did you finish? If not, indicate grade completed.
Name of school and location:
Major Subjects
Special Schooling or Training: Did you finish? If not, indicate grade completed.
Name of school and location:
Major Subjects
Professional Licenses and Certificates:
Please list the type, state, issued, date, and number for each license.

EMPLOYMENT HISTORY
List all previous employers for whom you have worked during the last five years. Explain any lapses between times when employed.
EMPLOYMENT #1
Name of Company
Address
Street Address Address Line 2 City State ZIP Code
Phone
Dates of Employment
Start Date
End Date
Salary
Position Held
Supervisor's Name
Reason for Leaving
EMPLOYMENT #2
Name of Company
Address
Street Address Address Line 2 City State ZIP Code
Dates of Employment
Start Date
End Date
Phone
Salary
Position Held
Supervisor's Name
Reason for Leaving
EMPLOYMENT #3
Name of Company
Address
Street Address Address Line 2 City State ZIP Code
Phone
Salary
Dates of Employment
Start Date
End Date
Position Held
Supervisor's Name
Reason for Leaving
Questions regarding employment history
Comments regarding lapses if applicable:
Have you ever been discharged from a job or forced to resign?
- Yes
- No
If yes, explain:
Have you ever been counseled, verbally or in writing, for violation of a prior employers safety rules?
- Yes
- No
If yes, explain:
Have you ever been counseled, verbally or in writing, for violation of any company policy of a prior employer?
- Yes
- No
If yes, please explain:

MILITARY SERVICE RECORD
The hiring and re-employment of veterans will be conducted in accordance with applicable state and federal laws and regulations.
Are you a member of a Reserve or National Guard unit?
- Yes
- No
Were you in the U.S. Armed Forces?
- Yes
- No
If yes, what branch? List what type of Discharge, Dates of Duty (From and To):
List duties in the military or special training that prepared you for the position you are seeking.
I hereby state that the information given by me in this application is true in all respects. I agree that, if I am employed and the information is found to be false in any respect, I will be subject to dismissal without notice at any time. I hereby authorize my former employers to release information pertaining to my work record, my work habits, and my work performance. In making application for employment, I understand that an investigative report may be made by a consumer reporting agency to include information as to my character, general reputation, personal characteristics, and mode of living, whichever may be applicable. If such an investigative report is made, I understand that I will receive notice that such a report has been requested, and that I will have the right to make a written request for a complete and accurate disclosure of additional information concerning the nature and scope of the investigation. I understand and agree that any employee handbook which I may receive will not constitute an employment contract, but will be merely a gratuitous statement of the Enterprise Health and Rehabilitation Center's current policies. I understand that the Enterprise Health and Rehabilitation Center reserves the right to require its employees to submit to blood tests or urinalysis for alcohol or drug screens, or allow inspection of bags (including purses or briefcases) or parcels brought into or taken out of the facility. I understand that refusal to submit to a urinalysis, blood tests or search, when requested to do so, may result in termination of my employment. I understand and agree that, if I am offered employment by Enterprise Health and Rehabilitation Center, my employment will be for no definite term and that either I, or Enterprise Health and Rehabilitation Center, will have the right to terminate the employment relationship at any time, with or without cause, and with or without notice and that this relationship can only be modified in writing and signed by the Administrator.
Signature counts as your legal signature.
Date:
Resume
Resume
Accepted file types: pdf.
Please attach your resume here. Only pdf files will be accepted. Thank you!
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PERSONAL INFORMATION

If you have lived at the above address for less than 12 months, list previous address below:

RECORD OF EDUCATION

EMPLOYMENT HISTORY

EMPLOYMENT #1

EMPLOYMENT #2

EMPLOYMENT #3

Questions regarding employment history

MILITARY SERVICE RECORD

Resume