Friendship Manor Employment Application

If you have submitted an application or resume in the last year please do not apply again. We retain applicant information for 12 months. Please know that we are giving your application much thought. Should your qualifications meet our requirements we will contact you directly. We will not return calls or e-mails that relate to application status due to our high volume of applications received. This process should take about 10–15 minutes of your time.

*Required information

Candidate Information

*Position(s) Interested In:
*First Name: Middle Name:
*Last Name:
Other Names:

*Social Security Number:
Drivers License Number (if applicable for desired position):

*Home Address (line 1):
Home Address (line 2):
*City/Town:
*State/Territory:
*Postal/ZIP Code:
*Primary Phone:
Alternate Phone:
*E-mail Address:
*Best way and time to reach you:
*Were you previously employed by this organization?
If yes, please provide date(s) and department/position:

Basic Career Information

*Career Level:
*Years of Relevant Work Experience:
Degree/Level Attained:
*Target Job Title:
U.S. Military Experience:
For RNs and LPNs, please list your License Number:
For CNAs, have you ever or are you currently working under a waiver?
*What are your preferred hours/shift?
*Are you willing to work other shifts?
*What is your work preference?
Are you available to work overtime?
Are you available to work weekends?
Are you available to work holidays?
Other Preferences:

Emergency Information

#1 Choice
Name of person to contact in case of emergency:
Relationship: Phone Number:
#2 Choice
Name of person to contact in case of emergency:
Relationship: Phone Number:

How did you hear about us?

How did you hear of the job opening?
(Please check one and list specifics on the side of each)
Current Friendship Manor Employee:
Newspaper Ad:
Internet Ad:
Friend, Relative, etc. Not Employed by Friendship Manor:
Just Dropped In
Other:

Education

High School:

College:

Graduate School:

Other:

Skills/Qualifications

List any special achievements, skills, or qualifications that are relevant to the position you applied for:

Miscellaneous

*Have you been convicted of a crime other than minor traffic offenses? Please do not disclose any convictions which have been sealed or expunged by a court (a conviction record will not necessarily be a bar to employment.)

If “Yes”, please describe in detail the nature and date of the conviction, and any rehabilitation that has since occurred:

*Are you either a U.S. citizen or an alien who has the legal right to remain and work in the United States? You will be required to furnish proof of legal work status if you are extended a job offer.

If you are under 18, are you able to furnish a work permit?

Work History/References

Please list present and former employers for the past 10 years, beginning with the most recent. All information must be completed. If your resume is provided, list the most recent position only. Note any gaps in employment. By listing any of the below, you are authorizing that we may contact all of the below references. We need to have at least two professional references (must be DIRECT SUPERVISORS) for each of your previous positions.
Select number of previous positions to include: 1 2 3

Resume Options

Choose how you want to create your resume:
Upload your Word document or pdf resume:
Copy and paste your resume :

Acknowledgements

Application Verification/Acknowledgement

By typing your initials and the date here, you agree to this verification and acknowledgement.
*Initials: *Today's date (xx/xx/xxxx):

Disclosure/Applicant Consent Form

By typing your initials and the date here, you agree to this disclosure.
*Initials: *Today's date (xx/xx/xxxx):

For more information please contact:
Dave Freeland, MS, PHR
Director of HR/Strategic Planning
309-794-4107
dave.freeland@friendshipmanor.org



	Employment Application If you have submitted an application or resume in the last year please do not apply again. We retain applicant information for 12 months. Please know that we are giving your application much thought. Should your qualifications meet our requirements we will contact you directly. We will not return calls or e-mails that relate to application status due to our high volume of applications received. This process should take about 10–15 minutes of your time. Required information Candidate Information Position(s) Interested In: First Name: Middle Name: Last Name: Other Names: Social Security Number: Drivers License Number (if applicable for desired position): Home Address (line 1): Home Address (line 2): City/Town: State/Territory: Postal/ZIP Code: Primary Phone: Alternate Phone: E-mail Address: Best way and time to reach you: Were you previously employed by this organization? If yes, please provide date(s) and department/position: Basic Career Information* Career Level: Years of Relevant Work Experience: Degree/Level Attained: Target Job Title: U.S. Military Experience: For RNs and LPNs, please list your License Number: For CNAs, have you ever or are you currently working under a waiver? What are your preferred hours/shift? Are you willing to work other shifts? What is your work preference? Are you available to work overtime? Are you available to work weekends? Are you available to work holidays? Other Preferences: Emergency Information #1 Choice Name of person to contact in case of emergency: Relationship: Phone Number: #2 Choice Name of person to contact in case of emergency: Relationship: Phone Number: How did you hear about us? How did you hear of the job opening? (Please check one and list specifics on the side of each) Current Friendship Manor Employee: Newspaper Ad: Internet Ad: Friend, Relative, etc. Not Employed by Friendship Manor: Just Dropped In Other: Education High School: College: Graduate School: Other: Skills/Qualifications List any special achievements, skills, or qualifications that are relevant to the position you applied for: Miscellaneous Have you been convicted of a crime other than minor traffic offenses? Please do not disclose any convictions which have been sealed or expunged by a court (a conviction record will not necessarily be a bar to employment.) If “Yes”, please describe in detail the nature and date of the conviction, and any rehabilitation that has since occurred: Are you either a U.S. citizen or an alien who has the legal right to remain and work in the United States? You will be required to furnish proof of legal work status if you are extended a job offer. If you are under 18, are you able to furnish a work permit? Work History/References Please list present and former employers for the past 10 years, beginning with the most recent. All information must be completed. If your resume is provided, list the most recent position only. Note any gaps in employment. By listing any of the below, you are authorizing that we may contact all of the below references. We need to have at least two professional references (must be DIRECT SUPERVISORS) for each of your previous positions. Select number of previous positions to include: 1 2 3 Position 1 Company Name: Phone Number: Address: City/State/Zip: Position(s) Held: Describe: Dates of Employment: From: To: Beginning Salary: Ending Salary: Reason for Separation: Supervisor and Title: Phone Number: Cell Phone: Fax: Other Phone: E-mail Address: CONTACT INFORMATION FOR REFERENCE VERIFICATION May we contact this employer? Position 2 Company Name: Phone Number: Address: City/State/Zip: Position(s) Held: Describe: Dates of Employment: From: To: Beginning Salary: Ending Salary: Reason for Separation: Supervisor and Title: Phone Number: Cell Phone: Fax: Other Phone: E-mail Address: CONTACT INFORMATION FOR REFERENCE VERIFICATION May we contact this employer? Position 3 Company Name: Phone Number: Address: City/State/Zip: Position(s) Held: Describe: Dates of Employment: From: To: Beginning Salary: Ending Salary: Reason for Separation: Supervisor and Title: Phone Number: Cell Phone: Fax: Other Phone: E-mail Address: CONTACT INFORMATION FOR REFERENCE VERIFICATION May we contact this employer? Resume Options Choose how you want to create your resume: Upload your Word document or pdf resume: Copy and paste your resume : Acknowledgements Application Verification/Acknowledgement By typing your initials and the date here, you agree to this verification and acknowledgement. Initials: Today's date (xx/xx/xxxx): Disclosure/Applicant Consent Form By typing your initials and the date here, you agree to this disclosure. Initials: Today's date (xx/xx/xxxx): For more information please contact: Dave Freeland, MS, PHR Director of HR/Strategic Planning 309-794-4107 dave.freeland@friendshipmanor.org