Application for Employment Ridgeview Assisted Living LLC Application for EmploymentRidgeview Assisted Living LLC does not discriminate in hiring or employment on the basis of race, color, religion, national origin, age, sex, disability, sexual orientation, Vietnam era military service, or any other basis on which discrimination is prohibited by federal, state, or local laws. No question on this application is intended to secure information to be used for such discrimination.Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. – Step 1 of 6PERSONAL INFORMATIONName *FirstLastAddress *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Are you 18 years of age or older? *YesNoNextEMPLOYMENT QUESTIONSPosition DesiredDate Available To Work *Salary Desired *Are you employed? *YesNoIf so, may we inquire of your present employer? *YesNoIf no, please explain: *Ever applied to this company before? *YesNoIf yes, where? *If yes, when? *Are you legally eligible to work in the US? *YesNoReferred by:Temporary AgencyAdvertisementEmployeeOtherEmployee Name *Other (referred by): *NextEDUCATIONHigh School/GED School Name and LocationYears AttendedDid you graduate?Subjects StudiedCollege School Name and LocationYears AttendedDid you graduate?Subjects StudiedTrade School School Name and LocationYears AttendedDid you graduate?Subjects StudiedOther School Name and LocationYears AttendedDid you graduate?Subjects StudiedNextEMPLOYMENT HISTORY Click "Add Additional Employer" at the bottom to add more (up to 4 more) Name of EmployerDates Employed (mm/yyyy to mm/yyyy)Employer PhonePositionAddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSupervisor's NameReason for Leaving Add Additional Employer Remove Employer NextREFERENCES applied Subjects Name List 3 personal references who are not related to you. Reference Name *Relationship/Title *Company Name and Address *Phone *Reference Name *Relationship/Title *Company Name and Address *Phone *Reference Name *Relationship/Title *Company Name and Address *Phone *NextADDITIONAL INFORMATIONPlease list any other job-related information you think would be helpful to us in considering you for the position, such as any additional work experience, volunteer activities, hobbies, social activities, clubs or professional organizations (list offices held), publications, accomplishments, etc. (Exclude information indicative of race, color, religion, sex, age, marital status, national origin, disability, or veteran status.)Paragraph TextSIGNATURE AND AUTHORIZATIONAcceptance of this application affords no assurance of eventual employment. If employed, you will be required to verify your ability to legally accept employment in the United States. For certain jobs, background investigations, to include contacting former employers, may be required. This application does not constitute a contract of employment. Employment and compensation can be terminated with or without notice, and with or without cause, at any time.Consent *I have read the foregoing instructions and question and to the best of my knowledge my answers are true and correct. I have not knowingly misrepresented or withheld any fact or circumstance that would, if disclosed, affect my application unfavorably. I understand that misrepresentation of any of the above may be cause for termination.Signature * Clear Signature Print Name *Today's Date *Submit
