All Care Employment Application

We consider applicants for all positions without regard to race, color,
religion, creed, gender, national origin, age, disability, marital or veteran
status, sexual orientation, or any other legally protected status.

Please fill-out the application below and submit to All Care upon completion.

ALL CARE APPLICATION FOR EMPLOYMENT

16 City Hall Square, Lynn, MA 01901 • 781-598-2454 •
ALL CARE IS AN EQUAL OPPORTUNITY EMPLOYER

Date of Application

Position(s) Applied For

How Did You Learn About Us?

Advertisement

Employment Agency

Friend

Relative

Walk-In

Other

Please Describe

Last Name First Name

Middle Name Social Security Number

Address (include number, street, apt. #)

City State Zip Code

Daytime Phone Cell Phone E-mail

If you are under 18 years of age, can you provide required proof of your eligibility to work?

Yes

No

Have you ever filed an application with us before?

Yes

No

If YES, please give date.

Have you ever been employed with us before?

Yes

No

If YES, please give date

Are you currently employed?

Yes

No

 

May we contact your present employer?

_________________________________________________________________________

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment.

Yes

No

Yes

No

On what date would you be available for work?

Are you available to work:

Full Time

Part Time

Shift Work

Temporary

Are you currently on "lay-off" status and subject to recall?

Yes

No

Can you travel if the job requires it?

Yes

No

Have you ever been convicted of a felony within the last 7 years?
Conviction will not necessarily disqualify an applicant from employment

Yes

No

If Yes, please explain:

Education

Name and Address of School

Course of Study

Years Completed

Diploma/Degree

Elementary School

High School

Undergraduate College

Graduate Professional

Other (Specify)

Indicate any foreign languages you can speak, read and / or write.

Fluent

Good

Fair

Read

Speak

Write

Describe any specialized training, apprenticeship, skills and extra-curricular activities.
Describe any job-related training received in the United States military.

Employment Experience

Employer

Dates Employed

Work Performed

Address

From

To

Telephone Number(s)
Job Title

Hourly Rate / Salary

Supervisor

Starting

Final

Reason for Leaving

Employer

Dates Employed

Work Performed

Address

From

To

Telephone Number(s)
Job Title

Hourly Rate / Salary

Supervisor

Starting

Final

Reason for Leaving

Employer

Dates Employed

Work Performed

Address

From

To

Telephone Number(s)
Job Title

Hourly Rate / Salary

Supervisor

Starting

Final

Reason for Leaving

Employer

Dates Employed

Work Performed

Address

From

To

Telephone Number(s)
Job Title

Hourly Rate / Salary

Supervisor

Starting

Final

Reason for Leaving

List professional, trade, business or civic activities and office held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status.

Additional Information

Other Qualifications

Summarize special job-related skills and qualifications acquired from employment or other experience.

Specialized Skills – Check Skill/Equipment Operated

CRT

Fax

Production/Mobile/Machinery (list):

Other (list):

PC

Lotus 1-2-3

Calculator

PBX System

Typewriter

Wordperfect

State any additional information you feel may be helpful to us in considering your application.

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Are you capable of performing in a reasonable manner the activities involved in the job or occupation for which you have applied? A description of the activities involved in such a job or occupation is attached.
Yes
No

References

1.

Name

Phone #

1.

Address/City/State/Zip

2.

Name

Phone #

1.

Address/City/State/Zip

3.

Name

Phone #

1.

Address/City/State/Zip

Applicant's Statement

I certify that answers given herein are true and complete to the best of my knowledge.


I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.


This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.


I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.


In the event of employment, I understand that false, or misleading information, or omissions to my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

Entering your NAME and the DATE below indicates that you agree to the terms above in applying for employment with All Care.
Signature of applicant Date

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