CAREERS

First Name

Last Name

Phone

Email Address

Street Address

City & State

Zip Code

Were You Previously Employed By A Partner Of Laurel Oaks? Were You Previously Employed By A Partner Of Laurel Oaks? *YesNo

When Were You Previously Employed?

How Did You Hear About Us?

Are you currently authorized to be lawfully employed in the United States? (Proof of eligibility will be required upon employment) Are you currently authorized to be lawfully employed in the United States? (Proof of eligibility will be required upon employment) YES NO

Have you been convicted of, pled guilty to, or pled no contest to a felony or is there a felony charge presently pending against you (do not include arrests, expunged and/or sealed convictions)? Even if the answer is “Yes”, it will not necessarily disqualify you for employment. However, if the answer is “Yes”, provide the crime, approximate date, and state and county of court action. Have you been convicted of, pled guilty to, or pled no contest to a felony or is there a felony charge presently pending against you (do not include arrests, expunged and/or sealed convictions)? Even if the answer is “Yes”, it will not necessarily disqualify you for employment. However, if the answer is “Yes”, provide the crime, approximate date, and state and county of court action. YES NO

Have you entered into any form of restrictive covenant (non-compete agreement, non-solicitation agreement, confidentiality agreement, etc.) with any past or present employer, person or entity, which would prohibit or interfere with your ability to be employed by Maple Ridge Manor or to fully perform the functions of the position for which you are applying? Have you entered into any form of restrictive covenant (non-compete agreement, non-solicitation agreement, confidentiality agreement, etc.) with any past or present employer, person or entity, which would prohibit or interfere with your ability to be employed by Maple Ridge Manor or to fully perform the functions of the position for which you are applying? YES NO

If “Yes,” you may be required to furnish a copy of such agreement to be considered for employment.

Are you at least age 18? Are you at least age 18? *YESNO

U.S. Military service? U.S. Military service? *YESNO

Position Applying For: Position Applying For: Caregiver Dietary Aid Administration Kitchen Maintenance

Date available to begin work:

What Hours Can You Work? What Hours Can You Work? *Full TimePart Time

What Days Can You Work?

Name of High School or Equivalent

Last Date Attended

Name of High School or Equivalent

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