Merrill Fields Assisted Living Employment Application
An Equal Opportunity Employer

Merrill Fields Assisted Living is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Applicants requiring reasonable accommodation in the application and/or interview process should notify a representative of the organization.
Name *
Enter first, middle and last name
Your answer
Have you ever used another name? *
Email
Your answer
Phone number *
Your answer
Alternate phone number
Your answer
Mailing Address *
Enter Street Address, City, State and Zip
Your answer
Are you 18 years of age or older? *
Desired Employment *
Check which days you are available to work *
Required
Check which shifts you are available to work *
Required
If hired, on what date can you start working? *
MM
/
DD
/
YYYY
It is required that you work every other weekend. Can you work on the weekends? *
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