APPLICATION FOR EMPLOYMENT
Clark Jeary Retirement Community
Date of Application *
MM
/
DD
/
YYYY
Name *
Last, First, Middle
Your answer
Address *
No & Street, Apt #, City, State, Zip
Your answer
Phone # *
Your answer
Cell Phone # *
Your answer
Type of Work Desired
First Choice *
Your answer
Shift *
Which Shift do you prefer for your first choice?
Your answer
Second Choice
Your answer
Shift
Which Shift do you prefer for your second choice?
Your answer
Availability *
Required
I CAN FURNISH THE PROPER DOCUMENTATION TO PROVE MY RIGHT TO WORK IN THE U.S. *
(i.e. picture ID and Social Security card, Birth Certificate, U.S. Passport, Certificate of U.S. Citizenship of Naturalization; unexpired foreign passport or resident aliend card, both with employment authorization, etc.)
Required
Are you at least 16 years of Age? *
Do you have any relatives working at Clark Jeary? *
Please be specific.
Have you ever been employed by Clark Jeary? *
If yes, please list dates and position
Your answer
Who referred you to us for employment? *
Required
Are you currently employed? *
May we contact your present employer? *
If your former employment references, education, or military service are under a different name than indicated, please list below
Last Name, First Name
Your answer
Employment History
Please list date range of employment, Name and Address of Employer, Salary, Position, Name of Supervisor and Reason for leaving
Most Recent
Your answer
2nd Most Recent
Your answer
3rd Most Recent
Your answer
Least Recent
Your answer
Education
High School
Name and Location of School, Dates Attended, Did You Graduate, Title or Degree earned, Major Subject
Your answer
College, Trade, Business or Correspondence
Name and Location of School, Dates Attended, Did You Graduate, Title or Degree earned, Major Subject
Your answer
Professional Licenses AND/OR Food Handlers Permit
Type, Organization or State Issued, Date Issued, Number
Your answer
References
Name three persons not related to you, whom you have known for at least one year
Reference 1 *
Name, Address, Phone, Business, Years Acquainted
Your answer
Reference 2 *
Name, Address, Phone, Business, Years Acquainted
Your answer
Reference 3 *
Name, Address, Phone, Business, Years Acquainted
Your answer
Have you ever been convicted of any offense other than minor traffic violations? *
If yes, list date, nature of offense and place:
Your answer
Please Read
I certify all the information submitted by me on this application is true and complete and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected.  In addition, if I am employed, my employment may be terminated at any time.
In consideration of my employment, I agree to conform to Clark Jeary rules and regulations.  I also agree that my employment and compensation can be terminated with or without cause and with or without notice at any time, at either mine or the company’s option.  I also understand and agree that the terms and conditions of my employment may be changed, with or without cause and with or without notice, at any time by the company.  I understand that no company representative, other than its administrator, and then only when in writing and signed by the administrator, has any authority to enter into any agreement for employment for any specific period of time or to make any agreement contrary to the foregoing.
Name *
by typing your full name, you certify the above
Your answer
Date *
MM
/
DD
/
YYYY
Email Address
Your answer
WE ARE AN EQUAL OPPORTUNITY EMPLOYER
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