Apply

Application for Employment

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital/ veteran status, or any other legally protected status. MVSL is a Safety Sensitive Campus, therefore Medical Marijuana Cards are prohibited.

Name

Date

Street Address

Phone

City/State

Social Security #

Position(s) applied for

How did you hear about us?

Advertising

Friend

Agency

Other:

Best time to contact you at the number provided is:

Have you ever applied with us?

Yes

If yes, give approximate date:

Have you ever been employed with us?

Yes

If yes, give approximate date:

Do any friends or relatives work here?

Yes

If yes, state name, relationship, and department:

Are you currently employed?

Yes

May we contact your current employer?

Yes

Do you have reliable transportation?

Yes

Have you ever been charged or convicted of a misdemeanor/ felony?

Yes

If yes, please give date and explanation:

Are you prevented from lawfully becoming employed in this country because of Visa or immigrant status?

Yes

Date available for work:

What is your desired salary range?

When are you available to work?

Full Time:

7:00am – 3:00pm

3:00pm – 11:00pm

11:00pm – 7:00am

Other:

Part Time:

Mornings

Afternoons

Evenings

Methodist Village Senior Living has staffing standards that must be met by State and Federal Regulations. Our policy states that four absences a year is excessive, do you agree and/ or are able to adhere to our policy?

Yes

Education

High School

Name & Address

Course of Study

Years Completed

Diploma/ Degree

Undergraduate College

Name & Address

Course of Study

Years Completed

Diploma/ Degree

Graduate/ Professional

Name & Address

Course of Study

Years Completed

Diploma/ Degree

Other (Specify)

Name & Address

Course of Study

Years Completed

Diploma/ Degree

State Licensure:

How Long?

Where?

Work Experience

Starting with your most recent job, include work experience, 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:

From:

To:

Address:

Phone Number:

Supervisor:

Job Title:

Work Performed:

Hourly Rate/Salary Start:

Hourly Rate/Salary Final:

May we contact?

Reason for Leaving:

Employer:

From:

To:

Address:

Phone Number:

Supervisor:

Job Title:

Work Performed:

Hourly Rate/Salary Start:

Hourly Rate/Salary Final:

May we contact?

Reason for Leaving:

Employer:

From:

To:

Address:

Phone Number:

Supervisor:

Job Title:

Work Performed:

Hourly Rate/Salary Start:

Hourly Rate/Salary Final:

May we contact?

Reason for Leaving:

Personal References: (Include name, relationship, & phone number)

Comments: (Include explanation of any gaps in employment)

Applicant’s Statement

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This 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 that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is 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 may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge. I understand; also, that I am required to abide by all rules and regulations of the employer.

By checking this box you affirm the above statement.

Methodist Village Senior Living Employment Reference Consent & Release

I hereby give consent to prior employers of mine to provide information about my employment with prior employers to prospective employers. By signing this consent, I am voluntarily requesting that the prior employer respond to reference requests from Methodist Village Senior Living.

I authorize the prior employer to disclose any employment-related information that may include:

Date and duration of employment
Current pay rate and wage history
Job descriptions and duties
The last written performance evaluation prepared prior to the date of request
Attendance Information
Results of drug or alcohol test administered within one year prior to request
Threats of violence, harassing acts, or threatening behavior related to the workplace or directed at another employee
Whether the employee was voluntarily or involuntarily separated from employment and the reasons for the separation
Whether the employee is eligible for rehire

RELEASE: I hereby release and discharge the prior employer and the prior employer’s successors, officers, directors, and agents for all claims, liabilities, and cause of action known or connected to its disclosure of employment – related information to a prospective employer. This release includes but is not limited to, claims of libel, slander, negligence, negligent misrepresentation, and interference with contract or profession.

I have carefully read and fully understand the provisions of this release. I acknowledge that I was given the opportunity to consult with an attorney and other individuals of my choosing before signing this release and that I have decided to sign this release voluntarily and without coercion or duress by any person.

This release sets forth the entire agreement between the prior employer and me, and I acknowledge that I have not relied upon any representation of statement, written or oral, not set forth in this document.

By checking this box you affirm the above statement.

Employee Questionnaire (Nursing Department Only)

1. How would you handle a situation where you are trying to work with a resident and they are mad or yelling at you?

2. What do you think you could bring to this facility to help maintain acuity of care?

3. What would you do if you found a resident on the floor?

4. Give an example of a time when you went above and beyond the call of duty?

5. Understanding the facility need for overtime, are you willing to comply?

6. Give an example of your ability to motivate a resident when they don’t want to take a bath.

7. What does the term teamwork mean to you?

8. Give an example of your ability to work as team.

9. Give an example of a time you were able to successfully communicate with another co-worker even though there was a past conflict.

10. How would you define success as a CNA?