Online Employment Application

Equal access to programs, services, and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and or interview process should notify a representative of the Human Resources Department.

Telephine Number
Telephine Number
Type Of Employment Desired
Have you ever been employed here before?
(If driving may be required in position for which you are applying)
Are you below the age of 18?
Are you legally authori zed to work in the United States?
Have you ever pled “g uilt y” or “no-contest” to, or been convicted of a crime?
Are you currently employed?
If so, may we inquire of your present employer?
Do you smoke?
Starting with your most recent employer, please provide the following information.
Employer Phone Number
Employer Phone Number
Employer Address
Employer Address
May we contact for reference?
Starting with your most recent school attended, PLEASE provide the following information:
Include city and state
Years Completed
Designation Earned

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and cl aims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no quest ion on this application is used for the purpose of limiting or eliminating any applicant fr om consideration for employment on a basis prohibited by applicable local, st ate or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and st ill wish to be considered for employment, it will be necessary to reapply and fill out a new application.

If I am hired, I understand that I am fr ee to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration.

I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and si gned by the employer's president. I understand that any offer of employment is contingent upon satisfactory results of a physi cal related to my job duties. I agree to submit to any future assessments as required by the position or by law. As part of our pre- employment screening process, Renaissance Senior Care Living requires a release and successful completion of any and/or all of the items listed below:

A drug screen
A criminal records check (fingerprinting)
A thorough personal and business reference check
A physical examination and TB test
Any other factors which are deemed to be appropriate

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.


By submitting this form, I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.