Employment Application Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. Serenity View Application for Employment Serenity View Assisted Living & Memory Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), national origin, age, disability, veteran status, genetic information, or any other status protected by law.Full Name *Email *Phone *Date of Birth *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDesired Position *eg: CNA, CMA, Chef, CaregiverFull Time, Part Time, or PRN?Full TimePart TimePRNDesired Schedule? Morning, Evening, or Night Time shift? Weekdays or Weekends? Availability? Employment EligibilityAre you legally authorized to work in the US? *YesNoAre you at least 18 years old? *YesNoCan you perform the essential functions of the position? *YesNoCriminal HistoryHave you ever been convicted of a criminal offense (excluding minor traffic violations)? *YesNoIf yes, please explain (a conviction will not automatically disqualify you from employment):EducationHigh School/GED NameGraduation DateDegree/CertificateCollege Name Graduation Date Degree/CertificateOtherGraduation Date Degree/CertificateLicensesTypeNumberState IssuedExpiration Employment HistoryEmployer Name *PhoneSupervisorPosition HeldDates EmployedAre you eligible for rehire?YesNoMay we contact?YesNoReason for Leaving?Employer Name *PhoneSupervisorPosition HeldDates EmployedAre you eligible for rehire?YesNoMay we contact?YesNoReason for Leaving?ReferencesName *RelationshipPhoneOccupation Name *RelationshipPhoneOccupation Name *RelationshipPhoneOccupation Resume UploadFile Upload Drag & Drop Files, Choose Files to Upload You can upload up to 2 files. Background Check Authorization (FCRA) of Name Drug I authorize Serenity View Assisted Living & Memory Care to obtain consumer reports and investigative consumer reports for employment purposes as permitted by the Fair Credit Reporting Act (FCRA). This authorization includes a criminal background check, verification of employment history, and review of applicable state and federal databases. I specifically authorize Serenity View Assisted Living & Memory Care to conduct searches of the Texas Nurse Aide Registry, Employee Misconduct Registry, and any other healthcare-related exclusion, abuse, or misconduct registries as required by state or federal law. Signature Clear Signature By signing, you agree to the Background Check Authorization Drug Screening AcknowledgmentI understand that employment with Serenity View Assisted Living & Memory Care may be contingent upon successful completion of a drug screening. I consent to such testing if required and understand that failure to comply or a positive result may result in withdrawal of a conditional offer of employment or termination, where permitted by law. Signature * Clear Signature By signing, you agree to the Drug Screening AcknowledgmentI certify that the information provided in this employment application is true, complete, and accurate to the best of my knowledge. I understand that any false, misleading, or incomplete information may result in disqualification from consideration or termination of employment if discovered after hire. Certification of Accuracy *YesNoI understand that employment with Serenity View Assisted Living & Memory Care is at will. This means that either the Company or I may terminate the employment relationship at any time, with or without cause or notice, in accordance with Texas law. I understand that nothing in this application or in any subsequent communication creates a contract of employment, express or implied. At-Will Employment Agreement *YesNoSignature * Clear Signature Verify you are human: * = Submit
