Application | North Star Manor

Application for Employment

We are an Equal Opportunity Employer and committed to excellence through diversity. This application must be fully completed to be considered. Please complete each section, even if you attach a resume.
Position Applied For*
Employment Desired*
- Full time
- Part time
Desired Pay
Available Start Date
PERSONAL INFORMATION
First Name*
Middle Name
Last Name*
Address*

Street Address

City

State

ZIP Code
Current Phone Number*
Email*
Are you legally eligible to work in the United States?*
- Yes
- No
If selected for employment, are you willing to submit a background check?*
- Yes
- No
Are you a veteran?*
- Yes
- No
Military Branch
Induction Date
Discharge Date

RECORD OF EMPLOYMENT

Please start with your current or most recent employer(s).
Employer
Current or Previous?
- Current
- Previous
Company
Job Title
Salary
Address

Street Address

City

State
Phone
Supervisor Name & Title
Employment Start Date
Employment End Date
Reason For Leaving
Employer
Current or Previous?
- Current
- Previous
Company
Job Title
Salary
Address

Street Address

City

State
Phone
Supervisor Name & Title
Employment Start Date
Employment End Date
Reason For Leaving
Employer
Current or Previous?
- Current
- Previous
Company
Job Title
Salary
Address

Street Address

City

State
Phone
Supervisor Name & Title
Employment Start Date
Employment End Date
Reason For Leaving
ADDITIONAL INFORMATION
Have you ever been fired or asked to resign from ANY job for any reason?*
- Yes
- No
If yes, where, when, and why?

REFERENCES

List 3 references who are present or former business associates (No relatives)

References

Name	Telephone	Company & Title

Click on the “+” to add additional rows.

SIGNATURE
I affirm that the information I have provided in this application is true to the best of my knowledge, information and belief, and I have not knowingly withheld any information requested. I understand that withholding or misstating any information requested in this application is grounds for rejection of my application, and that providing false or misleading information in this application is grounds for discharge.
I authorize the company to verify my references, record of employment, education record, and any other information I have provided. Unless otherwise noted, I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers and all other persons and entities, from any and all claims, demands or liabilities arising out of or in any way related to such inquiry or disclosure.
Signature*
Applicant's Name*
Date Completed*
Post Excerpt
Name

This field is for validation purposes and should be left unchanged.

Application for Employment