Cottonwood Manor Assisted Living - Cottonwood Manor Assisted Living - Dietary Supervisor

First name

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Last name

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Phone number (Mobile preferred)

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Upload resume (Optional)

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Street Address

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City, State, ZIP Code

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Are you looking for a:

Full-time Position

Part-time Position

PRN Position

Temporary Position

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Desired Shift:

1st

2nd

3rd

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Total Hours Per Week Desired:

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Are you available to work:

Weekends

Holidays

Overtime (as needed)

12 Hour Shifts

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Date Available to Start Work

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Minimum Salary Desired:

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Have you previously worked for or applied for a position with our Company, in any of our locations either as an employee or through an employment agency? If yes, please explain when and, if employed, in what capacity.

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Do you have any friends or relatives working at this Community?

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If yes, state name(s) and where they are located. (An answer of "Yes" will not automatically disqualify you from the position for which you are applying.)

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Do you currently hold a valid professional license or certification?

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Has your professional license ever been suspended?

Yes

N/A

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If yes, please explain.

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Are you 18 years of age or older?

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If under the age of 18, can you provide a valid work permit?

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Are you able to perform the essential functions of the job for which you are applying?

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If no, please describe the functions that cannot be performed:

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Education

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Name of High School, Location, Graduated (Y/N)

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Name of College, Location, Graduated (Y/N)

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Name of Other Training Institutions, Location, Graduated (Y/N)

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Please list all previous employment for the last 10 years, beginning with the most recent. If you need more room, you may include in the additional information section. If not applicable, enter "NA".

Work History 1 (Include Company, City, State, Phone, Position Held, Dates of Employment, May We Contact)

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Work History 2 (Include Company, City, State, Phone, Position Held, Dates of Employment, May We Contact)

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Work History 3 (Include Company, City, State, Phone, Position Held, Dates of Employment, May We Contact)

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List the name and telephone number of three business/work references who are not related to you, that we may contact. These references should be in addition to those listed in other sections on this application. If not applicable, list three personal references that are not related to you.

Reference 1 (Name, Phone Number, Relationship, Years Known)

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Reference 2 (Name, Phone Number, Relationship, Years Known)

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Reference 3 (Name, Phone Number, Relationship, Years Known)

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If you are hired, you will be required to produce original or certified documents establishing your identity and employment eligibility on your date of hire and a valid social security number for reporting the wages that you earn. Can you, after employment, provide verification of your legal right to work in the United States and a valid social security number?

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Have you ever been convicted of a criminal offense by any court? (Note: A conviction will not necessarily disqualify you from consideration for employment. The nature, date and circumstances of the offense as well as whether the offense is relevant to the duties of the position applied for may be considered.)

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If you have been convicted of a criminal offense, please state the nature of the crime(s), when and where convicted, and disposition of the case.

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Have you ever been convicted of an offense that would preclude employment in Assisted Living/Senior Living?

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Have you ever been excluded from participation in any Federal and/or State health care programs?

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THIS APPLICATION IS NOT COMPLETE UNTIL IT IS FULLY COMPLETED AND ALL STATEMENTS BELOW HAVE BEEN READ AND ACKNOWLEDGED.

I understand that I must complete and submit the Employment Verification Form (I-9) by providing documentation to establish identity and employment eligibility within three business days of the date employment begins. I further understand that I must provide a valid social security number for the purpose of reporting the wages I earn to the state and federal governments.

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I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application and for immediate discharge if I am employed, regardless of the time elapsed before discovery.

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I hereby authorize the Company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the Agency any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. I hereby waive and release the Agency, my former employers and all other persons, corporations, partnerships, and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigations or disclosure.

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I understand that nothing contained in the application, or conveyed during any interview, which may be granted, or during my employment, if hired, is intended to create an employment contract between the Company and me. In addition, I understand and agree that if I am employed by the Company, I will be an at-will employee, meaning my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either the Company or myself. No promises or representations contrary to the foregoing are binding on the Company unless made in writing and signed by the Company Executive Director.

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I understand that any offer of employment, as applicable, is contingent upon successful passing of a pre-employment and post-offer physical examination, criminal background check, reference checks, fingerprinting, suitability for employment processing, and other such pre-employment and post-offer exams as may be necessary or requested.

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NOTICE OF CRIMINAL BACKGROUND CHECKS

IN ORDER TO ENSURE THE SAFEST ENVIRONMENT FOR OUR RESIDENTS AND STAFF, THIS FACILITY CONDUCTS POST-OFFER/PRE-EMPLOYMENT CRIMINAL BACKGROUND SCREENING ON ALL APPLICANTS SELECTED FOR EMPLOYMENT. INDIVIDUALS WHO DO NOT SUCCESSFULLY PASS THESE SCREENINGS ARE NOT PERMITTED TO COMMENCE EMPLOYMENT.

Please ensure you've completed this application in its entirety. Complete this application even if you are attaching a resume. All employment decisions are made pursuant to a policy of providing equal employment opportunities consistent with federal, state or local laws. If you have a disability, which requires an accommodation in the application or interview process, please notify us in advance.

By selecting "I Agree", you are certifying that you have read and fully understand the above statements. Further, by selecting "I agree”, you are certifying that you are signing this document electronically and that your electronic signature is the legal equivalent of your manual/handwritten signature on this document.

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By submitting your application you authorize us to share your information with the Company posting the position and you agree to the terms of Workstream's Privacy Policy and Terms of Use, including receiving application updates and other offers from Workstream. You will receive a SMS confirmation message and one message per change in application status and appointment reminders. Reply HELP for help or STOP to opt out of short code SMS service. Message and data rates may apply.

Apply for Dietary Supervisor in Cottonwood Manor Assisted Living