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  1. Sunset Home
    114 College Avenue
    Waterville, 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.
  2. Date
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  3. Personal Information

  4. First Name
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  5. Middle Name
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  6. Last Name
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  7. Maiden Name
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  8. Email
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  9. Mailing Address
  10. Street
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  11. Town
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  12. State
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  13. Zip Code
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  14. Physical Address
    (if different from mailing address)
  15. Street
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  16. Town
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  17. State
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  18. Zip Code
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  19. Home Phone
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  20. Cell Phone
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  21. Last four digits of applicant's Social Security Number
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  22. If under 18 years of age, do you have a work permit?
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  23. If not a U.S. Citizen, do you have the legal right to remain permanently and work in the U.S.?
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  24. Alien Registration Number
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  1. EMPLOYMENT DESIRED

  2. Position applying for
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  3. Shift applying for
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  4. Status applying for
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  5. Date available to start

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  6. Have you ever applied for employment at Sunset Home before?
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  7. If yes, when
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  8. Have you ever been employed at Sunset Home?
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  9. If yes, when
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  10. What was your reason for leaving Sunset Home?
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  1. EDUCATION

  2. Highest Grade Completed














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  3. Name of Last School Attended
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  4. Certifications Held & Date Obtained
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  5. Licenses Held & Date Obtained (RN, LPN)
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  6. Other Training
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  1. WORK HISTORY

    Please list below your work experience, starting with your present or most recent employer
  2. Employer
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  3. Employer's Address
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  4. Position
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  5. Pay Rate
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  6. Supervisor
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  7. Dates of Employment
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  8. Reason for Leaving
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  9. Employer
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  10. Employer's Address
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  11. Position
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  12. Pay Rate
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  13. Supervisor
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  14. Dates of Employment
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  15. Reason for Leaving
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  16. Employer
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  17. Employer's Address
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  18. Position
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  19. Pay Rate
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  20. Supervisor
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  21. Dates of Employment
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  22. Reason for Leaving
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  23. May we contact your present employer at this time?
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  1. Have you ever been convicted of a crime?
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  2. If yes, please explain
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  3. Have you ever been convicted of any motor vehicle violations other than minor speeding infractions?
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  1. 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

  2. Please verify you are human
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