Application for Employment

1
Date of Application* This field is required.
Date
Month
Day
Year
2
Position Applying For
3
Full Name* This field is required.
First Name
Middle Name
Last Name
4
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Phone Number* This field is required.
6
SSN #
ex. 987-65-4321
7
Email* This field is required.
example@example.com
8
Are you at least 18 years of age?* This field is required.
YESNO
9
Are you at least 16 years of age?* This field is required.
YESNO
10
If less than 16 do you have a work permit?* This field is required.
YESNO
11
Have you ever been employed here before?* This field is required.
YESNO
12
If yes, give a date.* This field is required.
Date
Month
Day
Year
13
Are you employed now?* This field is required.
YESNO
14
If yes, may we contact your current employer?* This field is required.
YESNO
15
Can you, if hired submit verification of your legal right to work in U.S.?* This field is required.
YESNO
16
If hired, you will be required to submit documents sufficient to establish employment authorization & identify compliance with the immigration reform and control act of 1986. While you need not provide this proof of citizenship or immigration status at the time you are interviewed, please be prepared to assure us that you can do so immediately upon being hired.
17
On what date would you be available for work?
Date
Month
Day
Year
18
Expected Salary
19
Work Schedule Availability* This field is required.
Full Time
Part Time
20
If temporary, what days?
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
21
If temporary, what hours?
6-2PM
2-10PM
10-6AM
22
Are you on a lay-off and subject to recall?* This field is required.
YESNO
23
Give name, address, and telephone number of three references who are not related to you and are not previous employers.
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Ok
24
Have you ever been convicted of a crime in this state of any other?* This field is required.
YESNO
25
Do you have a record of founded child or dependent adult abuse?* This field is required.
YESNO
26
Signature* This field is required.I HAVE BEEN INFORMED BY HIRING PERSONNEL THAT AN IOWA CRIMINAL HISTORY/DEPENDENT ADULT ABUSE CHECK WILL BE CONDUCTED PRIOR TO HIRING. I HAVE ALSO BEEN INFORMED THAT MY NURSING/C.N.A. LICENSE WILL BE VERIFIED AT THIS TIME. BY SIGNING MY SIGNATURE, I GIVE PERMISSION TO PROMISE HOUSE TO PERFORM THIS CHECK.
ClearSignature
27
Education Level
High School
Undergraduate College
Graduate Professional
Other
28
High School Education Information
School Name
School Address
Course of Study
Years Complete
Yes
No
Diploma?
29
Undergraduate College Education Information
School Name
School Address
Course of Study
Years Complete
Yes
No
Degree?
30
Graduate Professional Education Information
School Name
School Address
Course of Study
Years Complete
Yes
No
Degree?
31
Other Education Information
School Name
School Address
Course of Study
Years Complete
Yes
No
Completed?
32
Employment Experience (Employer 1)Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race color, religion, gender, national origin, disabilities or other protected status
Employer
Address
Phone #
Job Title
Supervisor
Reason for Leaving
33
Start Date/End Date (Employer 1)* This field is required.
34
Hourly or Salary Employee? (Employer 1)* This field is required.
HourlySalary
35
Hourly Rate (Employer 1)
36
Annual Salary (Employer 1)
37
Work Performed (Employer 1)* This field is required.Please give a description of the work preformed for this employer.
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38
Employment Experience (Employer 2)Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race color, religion, gender, national origin, disabilities or other protected status
Employer
Address
Phone #
Job Title
Supervisor
Reason for Leaving
39
Start Date/End Date (Employer 2)* This field is required.
40
Hourly or Salary Employee? (Employer 2)* This field is required.
HourlySalary
41
Hourly Rate (Employer 2)
42
Annual Salary (Employer 2)
43
Work Performed (Employer 2)* This field is required.Please give a description of the work preformed for this employer.
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Ok
44
Employment Experience (Employer 3)Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race color, religion, gender, national origin, disabilities or other protected status
Employer
Address
Phone #
Job Title
Supervisor
Reason for Leaving
45
Start Date/End Date (Employer 3)* This field is required.
46
Hourly or Salary Employee? (Employer 3)* This field is required.
HourlySalary
47
Hourly Rate (Employer 3)
48
Annual Salary (Employer 3)
49
Work Performed (Employer 3)* This field is required.Please give a description of the work preformed for this employer.
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Ok
50
Additional InformationPlease upload resume (next page) and state any additional information you feel may be helpful to us in considering your application. Summarize special job-related skills & qualifications from employment or other experience.
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51
Resume Upload
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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52
Applicants Statement* This field is required.I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. The application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at the time. I hereby understand and acknowledge that unless otherwise defined by applicable law, any employment relationship with this organization is on an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application
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