Employment application

Name(Required)

Aurora Adult Day Care. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal levee. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative.

Please fill out all of the sections below

Applicant Information

Applicant Name(Required)

Address(Required)

City, State and Zip Code(Required)

Telephone Number(Required)

Applicant Email(Required)

Date of application(Required)

Employment Position

Position(s) applying for(Required)

How did you hear about this position?(Required)

On what date can you start working if you are hired?(Required)

Personal Information

Are you a US. citizen or approved to work in the United States?(Required)

Yes

What document can you provide as proof of citizenship or legal status?(Required)

Job Skills/Qualifications

Please list below the skills and qualifications you possess for the position for which you are applying

job skills(Required)

(Note

complies with the ALDA and considers

reasonable accommodation measures that may be necessary for eligible opplicants/employees to perform essential functions)

Education and Training

High School

Hight School Name(Required)

Hight School Location(Required)

Hight School Year Graduated(Required)

Hight School Degree Earned(Required)

College/University

University Name(Required)

University Location(Required)

University Year Graduated(Required)

University Degree Earned(Required)

Vocational School/Specilized Training

Vocational School Name(Required)

Vocational School Location(Required)

Vocational School Year Graduated(Required)

Vocational School Degree Earned(Required)

Military:

Are you a member of the Armed Services?

What branch of the military did you enlist?

What was your military rank when discharged?

How many years did you serve in the military?

What military skills(Required)

Previous Employment

Employer Name(Required)

Job Title(Required)

Supervisor Name(Required)

Employer Address(Required)

City, State and Zip Code(Required)

Employer Telephone

Dates Employed(Required)

Reason for leaving(Required)

Previous Employment

Employer Name(Required)

Job Title(Required)

Supervisor Name(Required)

Employer Address(Required)

City, State and Zip Code(Required)

Employer Telephone

Dates Employed(Required)

Reason for leaving(Required)

Previous Employment

Employer Name(Required)

Job Title(Required)

Supervisor Name(Required)

Employer Address(Required)

City, State and Zip Code(Required)

Employer Telephone

Dates Employed(Required)

Reason for leaving(Required)

Reference 1

Name(Required)

Company(Required)

Title(Required)

Phone(Required)

Email(Required)

Reference 2

Name(Required)

Company(Required)

Title(Required)

Phone(Required)

Email(Required)

AT-WILL EMPLOYMENT

The relationship between you and Aurora Adult Day Care

is referred to as "employment at will." This means that your employment can be terminated at any time for any reason,

with or without cause, with or without notice, by you or

Aurora Adult Day Care has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's President.

Employee Signature(Required)

Date(Required)

Aurora Adult Day Care LLC

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