BEL AIRE SENIOR LIVING - EMPLOYMENT FORM

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I am applying for the following Bel Aire

American Fork, UT

Orem, UT

EMPLOYMENT APPLICATION

Please complete the following application in its entirety. All employment decisions are made pursuant to our policy of providing equal opportunities without regard to race, color, national origins, ancestry, marital status, sex, age, or other non-job related physical handicaps. Your application will be considered with others who have also applied for this position.

Name (Last, first, middle initial)

Cell Phone

Email Address

Are You Over 16 Years of age?

YES

If you are selected for employment with Bel Aire Senior Living, you will be required to produce original or certified documents establishing your identity and employment eligibility. Can you, after employment, submit verification of your legal right to work in the U.S.?

YES

Desired employment

Desired salary

Shift(s) Desired

Part Time

Full Time

Days

Swing (Afternoon)

Nights

Date available

Desired total hours

Do you currently hold a professional license or certificate?

YES

Desired position

Administrator

R.N.

CNA

Food Handlers Permit

Other

Any Notes for Employer:

Date of availability

YYYY

I hereby certify that the entire information list herein is true and accurate to the best of my knowledge. I understand that any discovery of any false statements, misrepresentations or omissions of the requested material on this application shall be grounds for dismissal. I authorize investigation of any supplied on this application and hereby release my present and past employers and named references from any damages that may result from furnishing said information. Also I do consent that, if I am hired, my employment may be terminated at anytime either by myself or my employer; with or without just cause, for any or no reason. I certify that I have read the above statement and understand its terms.

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