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List your full Name*

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Email*

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Where did you learn of this job opening ?

Position Applying For• Date Available • Salary Desired

Shift Availability

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Are you available for Full or Part Time Work

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Ever been dismissed from employment due to abuse of clients or residents?*

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Ever been convicted of any misdemeanor involving theft, any felony, or any crime involving abuse or fraud?*

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Do you have a valid drivers license ?*

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Are you 21 years of age or older ?*

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List your High School, College, Trade, Business or Correspondence School Name • Studied • Did you graduate

List Employment Experience for past 10 years

Describe any specialized training, apprenticeship, skills and extra-curricular activities. Summarize special job-related skills and qualifications acquired from employment or other experience

List Three References

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Consent*

The facts set forth in my application for employment are true and complete. I understand that false statements on this application may be considered cause for rejection of this application or for termination of employment. I hereby authorize Welsh Mountain Home to investigate all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between Welsh Mountain Home and myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me and I understand that no such promise is binding upon Welsh Mountain Home. If an employment relationship is established, I understand that I have the right to terminate my employment at any time and that Welsh Mountain Home retains a similar right. If offered employment at Welsh Mountain Home, I consent to taking a pre-employment physical examination, drug screen and authorize Welsh Mountain Home to complete a Criminal Background Check in regard to the Older Adults Protective Services Act. I certify that I was never dismissed from employment due to abuse of clients or residents. I certify that I have no criminal history or conviction of a violent crime.

Applicant's Full Name

First Middle Last

Date

Online Application