Online Job Application

**READ THIS SECTION PRIOR TO PROVIDING SIGNATURE BELOW**

In consideration of my employment, I agree to conform to the policies and procedures of Friendship Manor. I understand that my employment can be terminated at any time and for any reason, at the option of either Friendship Manor or myself. I understand that no one has the authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing, except for a written employment agreement signed by the President/CEO.

I understand that neither the employment application, Friendship Manor Policy Manual, nor any other written document represents a contract or promise of continued employment.

I hereby affirm that the information on this application (and accompanying resume, if any) is true and complete.

I understand that any false or misleading representations or omissions may disqualify me from further consideration for employment and may result in discharge, if discovered at a later date.

I hereby authorize persons, schools, my current employer (if applicable) and previous employers and organizations named in this application (and accompanying resume, if any) to provide Friendship Manor with any relevant information regarding an employment decision, and I release from liability all persons or entities supplying or collecting such information.

It is the policy of Friendship Manor to provide equal employment and advancement opportunities to all individuals regardless of race, color, religion, sex, national origin, age or disability. All applicants are considered for employment and/or promotion based on their education, training, experience, skill, attitide and any other pertinent job requirement.

Employee Information
*First Name:
*Last Name:
*Address 1:
Address 2:
*City:
*State:
*Zip Code:
*Email Address:
* Phone Number:	() - Second partThird party
* Are you 18 years of age or older?:	Yes No
Have you worked under any other name?:	Yes No
*Are you a U.S. citizen or national, lawful permanent resident alien, or an alien authorized by the Immigration and Naturalization Service to work in the U.S.?:	Yes No
* Position Applying For:
* Salary Requirements:
* Can you perform the necessary functions of the job for which you are applying with or without reasonable accomodation?:	Yes No
If an accommodation would be necessary for you to be able to perform the essential and marginal functions of the job for which you are applying, please describe what accommodations would be required:
Education
High School Name and Address:
Did You Graduate High School?:	Yes No
College Name and Address:
College Major:
Did You Graduate College?:	Yes No
Grad School
Grad School Name and Address:
Major:
Did you Graduate Grad School?:	Yes No
Trade School
Trade School Name and Address:
Trade School Major:
Did You Graduate Trade School?:	Yes No
* Are there experiences, skills or qualifications, which you feel would especially fit you for the position for which you are applying and with Friendship Manor?:
Are you applying for:	Full-time Part-time
Shift Availability?:	1st 2nd 3rd
*Date you would be available to begin:
If applying for Part-time, check days available:	Mon Tue Wed Thu Fri Sat Sun
How were you referred to Friendship Manor?:
Do you have friends or relatives employed by Friendship Manor?:	Yes No
Have you ever been employed by Friendship Manor?:	Yes No
Job Reference #1
Former Job Title:
Employed From and To:
Employer's Name:
Phone number:	() -Second partThird part
Address of Previous Employer:
Supervisor's Name:
Job Duties:
Reason for Leaving:
May we contact previous/current employer?:	Yes No
Job Reference #2
Former Job Title 2:
Employed From and To:
Employer's Name:
Phone Number:	() - Second partThird part
Address:
Supervisor's Name:
Job Duties:
Reason for Leaving:
READ THIS SECTION PRIOR TO PROVIDING SIGNATURE BELOW In consideration of my employment, I agree to conform to the policies and procedures of Friendship Manor. I understand that my employment can be terminated at any time and for any reason, at the option of either Friendship Manor or myself. I understand that no one has the authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing, except for a written employment agreement signed by the President/CEO. I understand that neither the employment application, Friendship Manor Policy Manual, nor any other written document represents a contract or promise of continued employment. I hereby affirm that the information on this application (and accompanying resume, if any) is true and complete. I understand that any false or misleading representations or omissions may disqualify me from further consideration for employment and may result in discharge, if discovered at a later date. I hereby authorize persons, schools, my current employer (if applicable) and previous employers and organizations named in this application (and accompanying resume, if any) to provide Friendship Manor with any relevant information regarding an employment decision, and I release from liability all persons or entities supplying or collecting such information. It is the policy of Friendship Manor to provide equal employment and advancement opportunities to all individuals regardless of race, color, religion, sex, national origin, age or disability. All applicants are considered for employment and/or promotion based on their education, training, experience, skill, attitide and any other pertinent job requirement.
* Signature of Applicant Clear Signature