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
How Did You Learn About Us?
Last Name First Name
Middle Name Social Security Number
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?
Have you ever filed an application with us before?
If YES, please give date.
Have you ever been employed with us before?
If YES, please give date
Are you currently employed?
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.
On what date would you be available for work?
Are you available to work:
Are you currently on "lay-off" status and subject to recall?
Can you travel if the job requires it?
Have you ever been convicted of a felony within the last 7 years?
Conviction will not necessarily disqualify an applicant from employment
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)
Describe any specialized training, apprenticeship, skills and extra-curricular activities.
Describe any job-related training received in the United States military.
Employment Experience
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
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.
References
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.
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