KINDERHAFEN APPLICATION FOR EMPLOYMENT
We have current Openings for LPN/RN and accepting applications for CNA
Name *
First and last name
Your answer
Email *
Your answer
Phone number *
Your answer
Which position(s) do you prefer? *
Required
Are you at least 21 years of age?
Have you ever been convicted of a felony?
If yes please explain briefly
Your answer
Are you a citizen of the U.S. or do you have a legal right to work in the United States?
Washington State Ln, RN CNA or RNA license number?
Your answer
Do you have a current Driver's License?
Do you have current car insurance?
Employment and References
Previous Employer /From-To
Your answer
Reason for leaving
Your answer
Previous Employer/ From-To
Your answer
Reason for leaving
Your answer
Reference: Name and contact info
Your answer
Reference: Name and contact info
Your answer
Reference: Name and contact info
Your answer
Voluntary EEO Identification Form
Kinderhafen LLC believes all persons are entitled to equal employment opportunities and does not discriminate against its employees or applicants for employment because of race, color, sex, religion, national origin, disability, veteran status, age, marital status or any other protected status. Your completion of the information below is entirely voluntary. It will be seperated from your employment records and will not be used to make a decision about your employment. The employer is subject to certain governmental recordkeeping and reporting requirements for the administrarion of civil rights laws and regulations. In order to comply with these laws, the employer invites employees to voluntarily self identify their race and ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and will only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights, enforcement. When reported, data will not identify any specific individual.
Position applied for
Your answer
Date of Birth
MM
/
DD
/
YYYY
Gender
Race/ethnicity
Please indicate if you have disabled/veteran classification(s): Such self identification is submitted ona volutary, confidential basis, for use only in accordance with regulations and without subjecting the individual to adverse treatment.
Disabled/Veteran classification: only mark if applies
Attestation
by submitting this application, I attest that I am the applicant and the information provided in this application is complete and accurate, to the best of my knowledge. I understand that providing incomplete or inaccurate information may result in disqualification of application and may be a violation of state law(s). I understand and agree that any offer of employment is dependent upon satisfactory completion of pre employment investigation which includes but is not limited to education and work history verification, reference checks and support of my application(application references, background check results etc.) The company may also share information regarding applicant's employment with it's affiliatesand aopriate governmental or licensing entities. I understand the company requires background checks, and I consent to such checks. I further understand that if I am hired my employment will be for an indefinite period of time and will be "at will" which means that either I or Kinderhafen LLC may terminate the employment relationship at any time and for any or no reason.

Kinderhafen is comitted to providing a safe, healthy and productive work environment and supports a smoke free and drug free environment.

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