Mt. Olivet Rolling Acres | Employment | Apply Online

Personal Information

First Name:

Last Name:

Address:

Apt. #:

City:

State or Province:

ZIP or Postal Code:

Day or Home Phone:

Cell Phone:

Email Address:

Prior addresses in the past five years:

Prior names in the past five years:

Positon applied for:

Hours:

	Full Time (35-40 hours per week)
	Part Time (20-34 hours per week)
	Casual (less than 20 hours per week)

Shifts available for work (check all that apply):

	Sunday
	Monday
	Tuesday
	Wednesday
	Thursday
	Friday
	Saturday

Do you prefer:

	group home setting?
	one-to-one work in family homes?

How did you learn about this job opening?:

If OTHER, please provide more information:

Are you legally eligible for employment in the United States?:

	Yes
	No

Employment Application Information

Please use the fields below to tell us more about yourself.

Education
In the spaces below, please enter schools you have attended (including high school), start with the most recently attended.

School/City/State:

Years Completed:

Degrees Received:

Course of Study (Major/Minor):

School/City/State:

Years Completed:

Degrees Received:

Course of Study (Major/Minor):

School/City/State:

Years Completed:

Degrees Received:

Course of Study (Major/Minor):

School/City/State:

Years Completed:

Degrees Received:

Course of Study (Major/Minor):

Licenses

Do you have a license, certificate and/or registration?:

	Yes
	No

License/Certificate/Registration #:

Type:

State Issued:

Date Expires:

License/Certificate/Registration #:

Type:

State Issued:

Date Expires:

License/Certificate/Registration #:

Type:

State Issued:

Date Expires:

Do you have a valid driver's license? :

	Yes
	No

What state was your driver's license issued?:

Work Experience

Please start with the present or most recent employer. Include self-employment, part-time jobs, and period of U.S. Military Service.
(Note: Your social security number may be required for employment verification.)

Employer:

Address:

Telephone Number:

Length of Employment:

Position Title:

Brief Description of Duties:

Immediate Supervisor:

Reason for Leaving:

Salary Start:

Salary End:

Employer:

Address:

Telephone Number:

Length of Employment:

Position Title:

Brief Description of Duties:

Immediate Supervisor:

Reason for Leaving:

Salary Start:

Salary End:

Employer:

Address:

Telephone Number:

Length of Employment:

Position Title:

Brief Description of Duties:

Immediate Supervisor:

Reason for Leaving:

Salary Start:

Salary End:

Computer Use Assessment

In the event a job offer is made, we may ask you to demonstrate your computer skills.

Please indicate your computer skills by checking all that apply:

	Send and receive e-mail
	Save and print a document
	Use a mouse
	Find the help function on a menu
	Navigate the internet
	Find a toolbar
	Open a Word and/or Excel document

Miscellaneous

Have you ever been convicted of a felony or misdemeanor (other than traffic violations)?:

	Yes
	No

If YES, please describe here:

Do we have permission to implement a background check before a job offer is made?:

	Yes
	No

(Note: Any disqualification by the Commissioner of the Department of Human Services may be grounds for immediate dismissal.)

May we contact your current employer?:

	Yes
	No

Please indicate the maximum distance you would drive for your commute to work:

	10-20 miles
	20-30 miles
	30-40 miles

Mount Olivet Rolling Acres may require me to lift up to 50 pounds unassisted, carry up to 35 pounds unassisted and perform various tasks requiring normal range of motion:

I understand and agree:

	Yes
	No

Personal accomplishments and activities:

Outside interests/hobbies:

References

Indicate references' relationship to you, such as superior, co-worker, personal, etc.

Name:

Relationship/Position:

Address:

Telephone Number:

Name:

Relationship/Position:

Address:

Telephone Number:

Name:

Relationship/Position:

Address:

Telephone Number:

Mount Olivet Rolling Acres is an equal opportunity employer and will not discriminate against any applicant or employee on any grounds protected under the federal, state, or local law, including race, color, creed, religion, age, sex, sexual orientation, sexual harassment, national origin, ancestry, marital status, handicap, disability related to pregnancy or child birth, membership or activity in any local commission, status regarding public assistance, membership or non-membership in any labor organization, or any other characteristics, nor imply any limitation, illegal preferences, or discrimination based upon non-job-related information or protected characteristics.

If you are hired by Mount Olivet Rolling Acres, you will be employed as an at-will employee, meaning you may terminate your employment at any time for any reason. Similarly, if you are hired, Mount Olivet Rolling Acres will have the right to terminate your employment at any time, for any reason, without prior notice. No Mount Olivet Rolling Acres supervisor or manager has the authority to offer or promise anything other than at-will employment.

Applicant's Statement

I understand and agree that:

Any material misrepresentation or deliberate omission of a fact in my application may be justification for termination from employment.

By signing this application, I authorize Mount Olivet Rolling Acres to obtain and authorize all state, federal, or local law enforcement agencies or officials to release any and all information they have regarding any criminal convictions I may have, regardless of the date, location, or nature of the conviction.

I authorize any physicians or hospitals to release information that may be necessary to determine my ability to perform the duties of a job I am being considered for prior to employment or in the future during my employment with Mount Olivet Rolling Acres. I consent to a medical examination by a qualified physician at the discretion of my employer.

I understand that this is an application for employment and that no employment contract is being offered.

I understand that Mount Olivet Rolling Acres utilizes EVerify on all newly hired employees to confirm work authorization.

I have read and understand the above Applicant's Statement:

	Yes
	No

Colored fields indicate required information.

Employment Application Form