Manager Application

Full Name

Phone Number

Email Address

Physical Address

Are you over 18 years of age?

Yes

No

Weekend Availability

I'm available weekends

I'm not available weekends

How flexible are you to cover shifts and substitute for teammates, outside of your regular work schedule?

Highly Flexible

Somewhat Flexible

Rarely Flexible

Never Flexible

This position requires working some holidays and may require overtime, weekend work, and staying on shift until your relief arrives. Do you foresee any significant challenges in fulfilling these requirements?

Yes

No

If "Yes", please explain.

Do you have reliable transportation?

Yes

No

If you have any plans/appointments in the next three months that would conflict with your work schedule, please provide important information.

Date Available To Start

What is your expected salary range?

EDUCATION HISTORY

Provide the following information for each institution:
Name of School
Certification/Degree Earned
Year of Completion

SKILLS & ABILITIES

Are you restricted from lifting specific weights?

Yes

No

If "yes", please specify in pounds.

Are you able to transfer any person from bed to wheelchair and from wheelchair to bed or toilet or chair?

Yes

No

Have you dealt with incontinence (both bowel and bladder) and used incontinence products on any of your previous jobs?

Yes

No

What other skills/abilities do you have that pertain to this position?

Tell us about your leadership style.

What is it about this position and our business that is appealing to you?

Tell us why you believe you are a strong candidate for this position.

EMPLOYMENT HISTORY & REFERENCES

Are you currently employed?

Yes

No

Employment History

Provide the following information for each employer:

1. Employer/Company Name
2. Employer/Company Address
3. Dates Employed
4. Supervisor's Name
5. Supervisor's Contact Info
6. Description of Duties
7. Rate of pay
8. Reason for Leaving
9. Can we contact your supervisor?

REFERENCES

Provide the following information for each reference contact:
1. Name
2. Relation
3. Contact Info (Email & Phone #)

EMPLOYEE CREDENTIALS

(check the boxes of your current credentials)

What else would you like us to know about yourself?

To the best of my knowledge, the information I have provided in this application is true and accurate. I understand that if I am offered a job with your company, accept it, and later it is determined that my answers to any of the above questions are not truthful; I may be dismissed from employment.

Electronic Signature *

Date of Signature *

How did you hear about this open position? *

If other, please specify.

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