Employment Application

  • MM slash DD slash YYYY
  • If preferred shift is unavailable, will you work ?
  • If required, will you work:
  • For office use only
  • Beginning with your current or last employer, list the last four (4) positions of employment held, by date.
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY

  • GRANTING AND CONTINUED EMPLOYMENT IS CONDITIONED UPON FAVORABLE REFERENCES.

  • Max. file size: 64 MB.

  • RECORD INFORMATION RELEASE

    To Whom It May Concern:

    I have applied to: Unlimited Care for employment.. To enable Unlimited Care to properly evaluate my qualification, I request and authorize you to release and furnish to Unlimited Care any/all information in your records or files, or within your knowledge, concerning my present and/or past employment with you.

    I authorize all persons, schools, current/previous employers, and organizations named in this application or provided by me to the facility with any relevant information that may be requested by the facility. I also hereby release all parties seeking and providing information from any and all liability or claims for damages whatsoever that may result from this information’s release, disclosure, maintenance or use.
  • MM slash DD slash YYYY


  • UNLIMITED CARE

    In consideration of my employment I agree to conform to all of the rules and regulations of this facility and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either this facility or myself. 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 this facility. I understand that no representative of this facility, other than its Administrator, has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.

    I certify that I have read and understand the foregoing paragraphs. I further certify that all the information submitted by me on the application is true and complete to the best of my knowledge, and I understand that any false information, omissions, or misrepresentations of facts called for on this application may be cause for the denial of my application or, if I am employed, discharge at any time.

    As a condition of employment, I hereby consent to testing for drug and alcohol use, as determined to be appropriate by management, either before being hired or at any time during my employment with this facility.

  • MM slash DD slash YYYY


  • TO BE COMPLETED BY EMPLOYEE AFTER EMPLOYMENT