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.
Enter first, middle and last name
Have you ever used another name?
Alternate phone number
Enter Street Address, City, State and Zip
Are you 18 years of age or older?
Check which days you are available to work
Check which shifts you are available to work
First Shift (7:00am to 3:00pm)
Second Shift (3:00pm to 11:00pm)
Third Shift (11:00pm to 7:00am)
If hired, on what date can you start working?
It is required that you work every other weekend. Can you work on the weekends?
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This form was created inside of Merrill Fields Assisted Living.