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Application For Employment

PLEASE NOTE: All fields containing an asterisk (*) are REQUIRED. Form cannot be submitted until required fields are completed.

Position(s) Applied For:* Date of Application:*

PERSONAL DATA

Name:*
Address:*
City:* State:* Zip:*
Home Phone:* Work/Cell Phone:
Email:
Date available for work:* Salary expected:*
Type of employment desired:* Full-Time Part-Time Temporary

Have you ever been employed by CareLink before?* No Yes
If Yes, When? (From MM/DD/YY To MM/DD/YY):
Are any of your relatives employed with CareLink?* No Yes
If Yes, provide name(s):
Have you ever been convicted of a felony?* No Yes

EDUCATION

School Name:* Location:*
Degree:* Major:*
# Years Attended:* Graduated (Y/N)?*

License or Certificate:*

Office Skills: Microsoft Office Powerpoint Excel Access Typing WPM:

Provide any other information that you feel might be helpful:

EMPLOYMENT EXPERIENCE

List all positions held starting with your most recent. Include U.S. military service.

Employer One Name:*
Employer Location:*
Supervisor’s Name:*
Supervisor’s Title:* Supervisor’s Phone Number:*
Your Job Title:* Start Date:* End Date:*
Start Wages:* End Wages:*

Reason for leaving:*

Summary of duties:*

Employer Two Name:
Employer Location:
Supervisor’s Name:
Supervisor’s Title: Supervisor’s Phone Number:
Your Job Title: Start Date: End Date:
Start Wages: End Wages:

Reason for leaving:

Summary of duties:

Employer Three Name:
Employer Location:
Supervisor’s Name:
Supervisor’s Title: Supervisor’s Phone Number:
Your Job Title: Start Date: End Date:
Start Wages: End Wages:

Reason for leaving:

Summary of duties:

Employer Four Name:
Employer Location:
Supervisor’s Name:
Supervisor’s Title: Supervisor’s Phone Number:
Your Job Title: Start Date: End Date:
Start Wages: End Wages:

Reason for leaving:

Summary of duties:

REFERENCE AUTHORIZATION

May we contact your present employer?* Yes No

May we contact your former employer(s)?* Yes No

I agree that by submitting this form I authorize CareLink, or its agents to make inquiry of my employment history. Further, I hereby give consent to persons, schools, my current employer (if stated above) and previous employers named in this application (and accompanying resume, if any) to provide relevant information as may be requested by CareLink for thepurpose of making an employment decision. I agree that the submission will be the same as my written signature.

READ CAREFULLY BEFORE SIGNING

I certify that the answers given herein are true and complete to the best of my knowledge. I understand that intentional false statements could lead to my dismissal as an employee or rejection as an applicant.

I understand that any employment relationship with CareLink is of an "at-will" nature, which means that the employee may resign at any time for any reason and the employer may terminate employment at any time for any reason. It is further understood that this at-will employment relationship may not be changed by any written document or by conduct.

I understand that a drug and/or alcohol test may be required prior to employment and that any job offer is conditioned on satisfctory results of the test. I also understand that post-accident and random drug and alcohol testing may be done. I further voluntarily agree to such tests.

I understand that conviction of a crime may disqualify me from employment and that CareLink may request a criminal record check following any job offer. I also understand that any job offer is conditioned on satisfactory results of the criminal record check.

This application is valid for 45 days. At the end of 45 days, if I have not heard from CareLink and still wish to be considered for employment, it will be necessary to fill out a new application.

I agree that by submitting this form I am attesting to the accuracy of all information and that the submission will be the same as my written signature.

Attachment: Upload a copy of your resumé in PDF, TXT or DOC format.

Signature of Applicant:* Date:*

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