Careers

Employment Application

First Name* :

Last Name* :

Phone* :

E-mail :

Date of Birth :

Social Security Number :

Are you a citizen of the United States?
Yes No

If no, are you authorized to work in the U.S.?
Yes No

Address :

City :

State :

Zip :

What position are you applying for? *

Date Available to Start :

Please list days and times that are convenient for an interview :

Have you ever worked for Wedgwood Gardens Care Center?
Yes No

If yes, when?

Resume* : Please upload your resume in PDF or Word format.

Education

School

Name of School :

Type of School :

Location of School :

City :

State :

Zip :

Degree Received :

Major :

Number of Years Completed :

Previous Employment

Reference

Company Name :

Company Phone No. :

Company Address :

City :

State :

Zip :

Position Title :

Position Responsibilities :

Start Date :

End Date :

Starting Salary :

Ending Salary :

Reason for Leaving :

Supervisor Name :

Supervisor Position :

Phone :

May we contact your supervisor?
Yes No

Have you ever been on the OIG's List of Excluded Individuals Entities? (LEIE)
Yes No

This institution does not discriminate in hiring or any other decision on the basis of race, color, sex, citizenship, national origin, ancestry, veteran era, veteran status, or on the basis of age, or physical, or mental disability unrelated to ability to perform the work required. No question on this application is intended to secure information to be used for such discrimination. I voluntarily give this institute the right to make a thorough investigation of my past employment and activities, agree to cooperate in such investigation and release from all liability or responsibility all persons, companies or corporations supplying such information. I consent to take the physical examination and such physical examinations as may be required by this institute at such times and places as the institute may designate. I understand that an offer of employment may be contingent on passing the physical examination which relates to the essential duties I would be required to perform. I understand that my employment is at will, and that either party is free to terminate the employment relationship at time without cause. I also understand that my employment may be terminated for any misstatement or omission of fact appearing on this application form. If employed, I will be required to complete an Employment Verification Form (I-9), and within three business days show satisfactory evidence of identity and eligibility for employment.

By signing below, you are authorizing Wedgwood Gardens Care Center to perform a background check for purposes of evaluating whether you are qualified for the position for which you are applying.

Signature* :

Date* :

Welcome to

Wedgwood Gardens

Let our family guide your family on their care pathways

Careers

Employment Application

Education

School

Previous Employment

Reference