Carmel Application

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About Carmel

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We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.

Date of application
Last Name
First Name
Middle Name
Address (street, city, state, zip code)
Telephone number(s)
Social security number
Emergency contact name and phone number
Position(s) applying for

It is Carmel’s policy to hire only applicant who are 18 years of age or older. Do you meet this requirement?
Yes No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status (Proof of citizenship or immigration status will be required upon employment)
Yes No

Have you ever been convicted of a felony?
Yes No
If yes, please explain:

Date available for work

What is your desired salary range?

Are you available to work:
Full time Part time Weekends

Can you travel if a job requires it?
Yes No

EDUCATION

High School
Name and Address
Course of Study
Years Completed
Diploma/Degree

Undergraduate College
Name and Address
Course of Study
Years Completed
Diploma/Degree

Graduate School
Name and Address
Course of Study
Years Completed
Diploma/Degree

Other (Specify):

Describe any specialized training, apprenticeship, skills, and extra-curricular activities.

EMPLOYMENT EXPERIENCE
Start with you present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities, or other protected status.

These are the only employers that I have had in the last 7 years.
Yes No

Employer
Address
Telephone Number(s)
Job Title
Supervisor
Reason for Leaving
Dates Employed
Starting Hourly Rate/Salary
Final Hourly Rate/Salary
Work Performed

May we contact your present employer?
Yes No

Employer
Address
Telephone Number(s)
Job Title
Supervisor
Reason for Leaving
Dates Employed
Starting Hourly Rate/Salary
Final Hourly Rate/Salary
Work Performed

Employer
Address
Telephone Number(s)
Job Title
Supervisor
Reason for Leaving
Dates Employed
Starting Hourly Rate/Salary
Final Hourly Rate/Salary
Work Performed

Employer
Address
Telephone Number(s)
Job Title
Supervisor
Reason for Leaving
Dates Employed
Starting Hourly Rate/Salary
Final Hourly Rate/Salary
Work Performed

List professional, trade, business or civic activities and offices held.
You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status.

OTHER QUALIFICATIONS
Summarize special job-related skills and qualifications acquired from employment or other experience.

SPECIALIZED SKILLS (check skills)
Terminal
PC/MAC
Typewriter WPM
Spreadsheet
Word Processing
Shorthand WPM
Other (list)

State any additional information you feel may be helpful to us in considering your application.

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied?
Yes No

REFERENCES
Do not list relatives or former/current employees. List home phone and work phone.

Name
Address
Telephone Number(s)

Name
Address
Telephone Number(s)

Name
Address
Telephone Number(s)

APPLICANT’S STATEMENT
I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employments as may be necessary in arriving at an employment decision.

I hereby understand acknowledge that, unless otherwise defined by applicable law, any employment relationship with Carmel is of an “at will” nature, which means that the employee may resign at any time and the employer may discharge employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed b y any written document or by conduct unless such change is specifically acknowledge in writing by an authorized executive of Carmel Community Living Corp.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of Carmel.

Agree Disagree

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