Please complete all required fields! Sunset Home114 College AvenueWaterville, Maine 04901 APPLICATION FOR EMPLOYMENT Sunset Home is an equal opportunity employer and accepts applications for employment regardless of sex, age, race, national origin, color, religion, creed, sexual orientation, military status, workers compensation history, whistleblower or disability; physical or mental. Date Invalid Input Personal Information First Name Invalid Input Middle Name Invalid Input Last Name Invalid Input Maiden Name Invalid Input Email Invalid Input Mailing Address Street Invalid Input Town Invalid Input State Please ChooseAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming Invalid Input Zip Code Invalid Input Physical Address (if different from mailing address) Street Invalid Input Town Invalid Input State Please ChooseAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming Invalid Input Zip Code Invalid Input Home Phone Invalid Input Cell Phone Invalid Input Last four digits of applicant's Social Security Number Invalid Input If under 18 years of age, do you have a work permit? YesNo Invalid Input If not a U.S. Citizen, do you have the legal right to remain permanently and work in the U.S.? YesNo Invalid Input Alien Registration Number Invalid Input Next > EMPLOYMENT DESIRED Position applying for Invalid Input Shift applying for DayEveningNight Invalid Input Status applying for Per DiemPart-TimeFull-Time Invalid Input Date available to start Invalid Input Have you ever applied for employment at Sunset Home before? YesNo Invalid Input If yes, when Invalid Input Have you ever been employed at Sunset Home? YesNo Invalid Input If yes, when Invalid Input What was your reason for leaving Sunset Home? Invalid Input < PrevNext > EDUCATION Highest Grade Completed 101112/GEDAssociates DegreeBachelors DegreePost Graduate Degree Invalid Input Name of Last School Attended Invalid Input Certifications Held & Date Obtained Invalid Input Licenses Held & Date Obtained (RN, LPN) Invalid Input Other Training Invalid Input < PrevNext > WORK HISTORY Please list below your work experience, starting with your present or most recent employer Employer Invalid Input Employer's Address Invalid Input Position Invalid Input Supervisor Invalid Input Dates of Employment Invalid Input Reason for Leaving Invalid Input Employer Invalid Input Employer's Address Invalid Input Position Invalid Input Supervisor Invalid Input Dates of Employment Invalid Input Reason for Leaving Invalid Input Employer Invalid Input Employer's Address Invalid Input Position Invalid Input Supervisor Invalid Input Dates of Employment Invalid Input Reason for Leaving Invalid Input May we contact your present employer at this time? YesNo Invalid Input < PrevNext > APPLICANT’S STATEMENT By submitting this application you acknowledge and agree to the following. Should you be asked to come in for an interview, you will be required to sign a print out of this document. I understand that any employment by Sunset Home will be on a 90-day probationary period. If employed by Sunset Home, I agree to comply with the Home’s policies, procedures, rules and regulations. The above information is complete and true to the best of my knowledge. I understand discovery of misrepresentation or omission of facts herein will be cause for immediate dismissal. I authorize Sunset Home to contact the three (3) references, which I have provided and signed a release form. I agree to take a physical examination at any time, at the request of Sunset Home, and agree that the examining physician may disclose the findings/results to Sunset Home. ______________________________ PRINT FULL NAME ______________________________ APPLICANT’S SIGNATURE ____________________ DATE Please verify you are human(*) Invalid Input < PrevSubmit
