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Full Legal Name
*
Present Address
How long have you lived there?
*
Previous Address
*
How long did you live there?
Telephone Number
Are you 18 years or older?
*
Yes
No
Have you ever worked for Magnolia Place Senior Living?
*
Yes
No
If Yes, Please Give Dates and Position:
Do you have any friends or relatives working here?
Yes
No
If Yes, Name and Position
Have you ever pled guilty or “no contest” to a felony, been convicted of a felony, had adjudication withheld, prosecution deferred or do you have any criminal charges pending?
*
Yes
No
If Yes, please give date and details of each:
PREVIOUS EMPLOYMENT HISTORY
Please list the names of your present or previous employers in chronological order with present or last employer\\nlisted first. Be sure to account for all periods of time including any period of unemployment.
Employer 1:
Name of Employer
Address
Phone Number
Dates of Employment
Your Position and Duties
Supervisor/Manager
Reason For Leaving
Employer 2:
Name of Employer
Address
Phone
Dates of Employment
Your Position and Duties
Supervisor/Manager
Reason For Leaving
Employer 3:
Name of Employer
Address
Phone
Dates of Employment
Your Position and Duties
Supervisor/Manager
Reason For Leaving
Employer #4
Name of Employer
Address
Phone
Dates of Employment
Your Position and Duties
Supervisor/Manager
Reason For Leaving
Explain Gap in Work History, if any.
Have You Ever Been Terminated From a Job?
*
Yes
No
If Yes, please explain circumstances:
EDUCATION:
High School Name
Number of High School Years Completed
Did You Graduate High School?
Yes
No
College Name
Number of College Years Completed
Did you Graduate College?
Yes
No
Graduate/Professional Name
Number of Graduate/ Professional Years Completed
Did You Graduate Graudate and Professional School?
Yes
No
Trade/Correspondence
Number of Trade/Correspondence Years Completed
Did You Graduate Trade/Correspondence School?
Yes
No
PERSONAL REFERENCES
Personal Reference #1
Personal Reference #2
Personal Reference #3
PLEASE READ CAREFULLY AND SIGN BELOW *
This application will be considered active for a maximum of thirty (30) days. If you wish to be considered for employment after that time, you must reapply.
This company is an equal opportunity employer and does not discriminate because of race, color, religion, sex, age, marital status, disability, veteran status, national origin, pregnancy, genetic information, sexual orientation, gender identity, or any other protected category
I HEREBY CERTIFY that all of the information that I have provided in this application is true and accurate.
Submit
