Apply Online

Thank you for applying at May Creek Senior Living Campus.
Please answer all questions.

Name:
  Last First Middle

Address:
  Number & Street City State Zip

E-mail:

Phone no: Cell no:

I am interested in employment at: Assisted Living Lodge
  Memory Care Cottages

Position(s) desired:

How many hours per week are you wanting to work?

Have you applied with this company before? YES
  NO

Education: Name & Address of School Degree/Diploma Graduation Date
High School
College
Trade, Business, Other

Special Skills & Qualifications: (List job-related licenses, skills, training, honors)

Employment History: (Start with present or last position)

Employer Address:
Supervisor: Phone:
Position Title: Start Date: End Date:
Duties:
Salary: (First) (Last) Reason for Leaving:

Employer Address:
Supervisor: Phone:
Position Title: Start Date: End Date:
Duties:
Salary: (First) (Last) Reason for Leaving:

Employer Address:
Supervisor: Phone:
Position Title: Start Date: End Date:
Duties:
Salary: (First) (Last) Reason for Leaving:

We may call the above employers for references

References: (Personal, not family)
Name & Title:
Address & Phone #:
Occupation
   
Name & Title:
Address & Phone #:
Occupation

Have you been convicted of or pleaded no contest to a felony within the last five years?

Yes No
If yes, please explain

I certify that information contained in this application is true and complete. I understand that false, misleading, or incomplete information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any and all information listed above, and by signing this application, I authorize May Creek Senior Living Campus to complete a background investigation and reference checks.

Name Date