Employment Application

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PERSONAL INFORMATION
Please come in to fill out an application or finish this online application completely. We will need a complete application, regardless of whether or not you are submitting a resume. Bridgeview Post Acute is an Equal Opportunity Employer. All hiring decisions are made without respect to race, sex, religion, sexual orientation, age, disabilities, or some any other protected status.
Date
Name*
First Middle Last
Cell Phone*
Home Phone*
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
How long have you lived there?
Years/Months
Are you at least 18 years of age?
- Yes
- No
If no, can you furnish a valid work permit?
- Yes
- No

EMPLOYMENT HISTORY
Please list all employment for the last 10 years starting with the most recent employer. Account for all periods of unemployment. You must complete this section even if submitting a resume.
MOST RECENT EMPLOYER
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Name of Supervisor
Position Held
Reason for Leaving
Date started
Date left
Starting salary: $/per
Ending salary: $/per
May we contact?
- Yes
- No
If no, why not?
How much notice did you give when resigning?
If less than two weeks, why?
PREVIOUS EMPLOYER
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Name of Supervisor
Position Held
Reason for Leaving
Date Started
Date Left
Starting salary: $/per
Ending salary: $/per
May we contact?
- Yes
- No
If no, why not?
How much notice did you give when resigning?
If less than 2 weeks, why?
PREVIOUS EMPLOYER
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Name of Supervisor
Position Held
Reason for Leaving
Date started
Date left
Starting salary: $/per
Ending salary: $/per
May we contact?
- Yes
- No
If no, why not?
How much notice did you give when resigning?
If less than 2 weeks, why?

WORK REFERENCES
List three business/work-related references who are not related to you who have knowledge of your work performance within the past three years.
Name
First Last
Phone
Occupation
Number of years acquainted?
Work Reference #2
Name
First Last
Phone
Occupation
Number of years acquainted?
Work Reference #3
Name
First Last
Phone
Occupation
Number of years acquainted?
PERSONAL REFERENCES
List two personal references who know you well that we may contact.
Name
First Last
Phone
Occupation
Number of years acquainted?
Personal Reference #2
Name
First Last
Phone
Occupation
Number of years acquainted?
Applicant's Certification and Agreement
Please read carefully, initial each paragraph, and by signing your name at the end, this will count as your legal signature.
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances of employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application and for immediate discharge if I am employed, regardless of the time elapsed before discovery.
I understand that I must complete and submit Employment Verification Form (I-9) by providing documentation to establish identity and employment eligibility on or before the first day of work.
I hereby authorize the company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company and and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. I hereby waive and release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigations or disclosure.
I understand that nothing contained in the application, or conveyed during any interview, which may be granted, or during my employment, if hired, is intended to create an employment contract between the company and me. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either the company or myself. No promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by the company Administrator.
I have read and fully understand the previous statements
Applicants Signature. Type your full name here. This will count as your legal signature.
Date
Full Legal Name
First Last
Date
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Resume
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Phone
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