Anchored Heart Employment Application

Please complete all required fields in this employment application. Your information will remain confidential and is used solely for hiring consideration.

Contact Information

Full Name

Email

Current Address

Phone

Birthday

Month

Day

Year

Work Schedule

Available start date

Employment Preference

Full Time

Part Time

Temporary

On Call

Choose all that apply.

Schedule Preference

First Shift (6am - 2pm)

Afternoon Shift (2pm - 10pm)

Night Shift (10pm - 6am)

On Call

Are you able to work 8 hour shifts?

Yes

No

Are you able to work holidays?

Yes

No

Please describe any commitments or outside responsibilities which would require your absence from work.

Is there any type of work which your physical condition prohibits, or have you ever been advised by a doctor not to perform certain types of work? If yes, please explain.

Additional Information

Have you ever been convicted of a criminal offense involving the abuse or intentional neglect of an elderly or vulnerable individual. If yes, please explain.

Have you ever been convicted of any crime greater than a traffic violation? If yes, please explain.

Are you authorized to work in the United States?

Yes

No

Do you have a state-issued drivers license?

Yes

No

Drivers License / State ID

Record of Employment

Upload your resume

Professional References

Personal Reference #1

Please include your reference's full name, phone number, and their relationship to you.

Personal Reference #2

Please include your reference's full name, phone number, and their relationship to you.

Personal Reference #3

Please include your reference's full name, phone number, and their relationship to you.

Please read carefully and check the box next to each paragraph before submitting.

I certify that all of the statements made by me on this application and in any interview are true, complete, and correct to the best of my knowledge. I hereby grant permission to Anchored Heart Senior Living and its personnel to confirm by personal inquiry or otherwise the information I give in the employment process. I understand that any willful misrepresentation or omission of facts given in this process is grounds for rejection of this application and dismissal if employed.

I agree

I hereby authorize the company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I agree

I authorize Anchored Heart Senior Living to release to any person, firm, entity, or organization with which I may seek employment in the future, any truthful information concerning my work experience with Anchored Heart Senior Living. I hereby release and hold Anchored Heart Senior Living harmless from any claim for releasing any truthful information within its knowledge and/or records.

I agree

I understand that prior to any job offer extended to me will be contingent upon the successful completion of any required criminal background check, and/or any other drug testing requirement.

I agree

I further understand that, if hired, my employment is for no definite period of time and that either the Company or I may terminate our relationship at will at any time, without notice or any reason, and that this employment application does not constitute an employment contract.

I agree