Employment

Your Information

Your Name

Please leave this field empty.

Your Current Address (required)

Your Phone Number (required)

Your Email (required)

Are you currently over 18 years of age? (required)
YesNo

Employment Desired

Position Desired (required)

Date you can start (required)

Salary Desired (required)

Type of Employment Desired (required)
Part TimeFull-TimePRNTemporary

Desired Schedule (required)
DayEveningsNightsWeekends

Were you previously employed by us? (required)

Reason For Leaving?

Are you related to, or know a current Employee at our Facility?

How did you hear about this position?

Employment History

List Your Record Starting with Your Most Recent Position

Start Date: End Date:

Currently Employed? YesNo

Describe the work you did

Next Record:

Start Date: End Date:

Currently Employed? YesNo

Describe the work you did

Next Record:

Start Date: End Date:

Currently Employed? YesNo

Describe the work you did

Highest Level of Education | List from Most Recent to Oldest

High SchoolOther EducationAssociates DegreeBachelors DegreeMasters Degree

Name of School, Major (when applicable) and Year Graduated (required)

Name of School, Major (when applicable) and Year Graduated (optional)

Name of School, Major (when applicable) and Year Graduated (optional)

Emergency Contact

In case of Emergency Notify (required)

Or

Military Service Record

Have you ever served in the Armed Forces?

From:

To:

List of Duties

Present Membership in National Guard or Reserves?
YesNoN/A

Upload your resume.pdf, .doc, .docx, .odt

Upload your Cover Letter .pdf, .doc, .docx, .odt

I authorize The Salem Circle of Care LLC to contact each former employer, firm or corporation. I authorize any of these persons to give all information concerning work-related items and I release all parties from liability for any damage that may result from furnishing the same to you.
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed; falsified statements on this application shall be grounds for dismissal.
I also understand that if accepted by Salem Circle of Care LLC, my employment is voluntarily entered into and I am free to resign at any time. Similarly, Salem Circle of Care LLC is free to conclude my employment at any time. I further recognize that this application is not a contract and cannot create a contract.

I agree: (required)

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