Home
About
Services
- Short Term Stays
- Summerhill's Spiritual Side
Assisted Living
- Virtual Tour
- Photo Album
Memory Care
- Virtual Tour
- Photo Album
Testimonials
News

Home
Job Application

Increase size

Reset to Default

Decrease size

Job Application

Apply Online

Submission Preview

…

Name*

Phone number (day)

Email Address*

Phone number (evening)

Are you younger than 18 years of age?*

No

Yes

Mailing Address

Which position are you applying for?

Potential Start Date

Salary Desired:

Your Availability:

Full time

Part time 20

Part time

Per diem

Days

Evenings

Overnights

Weekends

Are you currently employed?*

Yes

No

May we inquire of your current employer?

Yes

No

Have you ever applied to or worked for Summerhill before?*

Yes

No

List most recent month and year of employment and position

Do you currently hold a valid healthcare license?*

Yes

No

If yes, which?

Have you ever worked with the elderly before and in what capacity?

Have you ever been convicted of a misdemeanor or felony?*

Yes

No

If yes, describe full:

Have you ever been convicted of abuse, assault, neglect, or exploitation of any person?

Yes

No

How did you learn about us?

Advertisement

Friend

Walk-in

Relative

Employee (if yes please write the employee's name below)

Resident

Other

Are you qualified to perform all of the functions for which you are applying (see job description)?*

Yes

No

If not, please explain:

Education - High School and State

Course of Study

Diploma/Degree Received

College - School and State

Course of Study

Diploma/Degree Received

Trade, Business, Other Education - School and State

Areas of special study, uniques skills or interest:

Course of Study

Diploma/Degree Received

Previous Employer #1

Dates of Employment

Responsibilities (if not listed on resume)

Permission to check with employer

Yes

No

City, State

Supervisor(s)

Position(s) Held

Phone Number

Reason for Leaving

Ending pay

Previous Employer #2

Dates of Employment

Responsibilities (if not listed on resume)

Permission to check with employer

Yes

No

City, State

Supervisor(s)

Position(s) Held

Phone Number

Reason for Leaving

Ending pay

References #1 Name

Daytime Phone#

What is your relationship with this person?

Supervisor/Manager

Co-Worker

Friend

References #2 Name

Daytime Phone#

What is your relationship with this person?

Supervisor/Manager

Co-Worker

Friend

Resume or CV

Follow us on Facebook

Summerhill Assisted Living

Copyright © 2017 Summerhill Assisted Living. All rights reserved.

Site maintained by Windhill Design LLC

Facebook