APPLICATION FOR EMPLOYMENT All information obtained in this form will be held in strict confidence, subject to applicable law. We will not discriminate because of sex, age, race, physical disability, religion, ethnicity, marital status, ancestry, or place of origin. Your Name* First Name Last Name Your Email* Address Street City State ZipCode Day Time Phone What position are you applying for? Which Sun Valley location are you interested in? North County - Bellefontaine NeighborsSouth City - Chippewa Referred By Date you are available to work Are you legally eligible to work in the U.S.? YesNo Are you willing to have your criminal background checked? YesNo How many hours do you want to work per week? 0-1010-2020-3030-4040+ What days are you most interested in working? WeekdaysWeekends What times of day are you most interested in working? MorningsAfternoonsEvenings WORK HISTORY / EXPERIENCE Please list your 3 most current work history/experience Please describe your experience and what makes you an ideal candidate for employment? EMPLOYER 1 Employer's Name (Most current) Position Held Supervisor's Name Telephone Reason for Departure Duties Start Date End Date May we contact this employer? YesNo If NO, reason why not EMPLOYER 2 Employer's Name (Most current) Position Held Supervisor's Name Telephone Reason for Departure Duties Start Date End Date May we contact this employer? YesNo If NO, reason why not EMPLOYER 3 Employer's Name (Most current) Position Held Supervisor's Name Telephone Reason for Departure Duties Start Date End Date May we contact this employer? YesNo If NO, reason why not YOUR CLIENT CARE PHILOSOPHY As you know, several people are involved in the care of an individual. Please describe how you see your role as a member of the healthcare team. Do you have any of the following certifications? Certified Nurse AideFirst AidCPRClass E Drivers LicenseLevel 1 Medication AideMedical AssistantMANDT CPI Other Which of these statements are true about Range of Motion (ROM) exercises? They help prevent stroke and paralysis.They are generally performed during ADLs such as bathing or dressing.You can do them any time you like. When walking an individual, a gait belt is often... Put around the individual's waist to provide a way to safely hold on to them.Used to keep an individual positioned properly in a wheelchair.To hold the individuals pants up. When an individual is expressing anger, the Direct Care Professional should... Remind the person that everyone gets angry.Listen closely to the person's concerns.Call for help. REFERENCES We DO NOT consider OR interview anyone who cannot provide 3 references (work, education or church related). NO FAMILY MEMBERS. Reference (1) Name Telephone Reference (2) Name Telephone Reference (3) Name Telephone FALSE INFORMATION I hereby state that all information provided is accurate and may be verified by you. I agree that I may be discharged if this company at anytime learns of falsification or material omission in the information provided on this application form and related documents. You may contact my former employers. All references are hereby authorized to release all information which they may have relevant to my employment with them. I hereby release Sun Valley Adult Care Center® , its affiliates, successors, and assigns, and all references from any liability that might be claimed because of information provided by such references. I agree that I will follow all Sun Valley Adult Care Center® policies, rules, and procedures. I understand that Sun Valley Adult Care Center® reserves the right to add, change, and/or delete any policies, procedures, work rules, and/or benefits at anytime. I agree to make myself available for random drug testing. I agree to the disclosure of and and all convictions of felony and criminal charges pending against me. Do you have or are you able to acquire CPR/First Aid certification prior to your date of employment if a position is offered?* Yes, I already have a current CPR/First Aid certificate.No, but I can acquire my CPR/First Aid certificate before being employed.No Click below to upload your resume Type Signature
