Saxony Health Center, LLC d/b/a Saxony Health Center subscribes to a Non-Discrimination Policy.
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EMPLOYMENT
We consider applicants for all positions on the basis of qualifications and without regard to race, color, religion, sex, national origin, age, marital status, veteran status, disability, sexual orientation, use of lawful products during non-work hours and any other legally protected status.
Please fill out this form completely and accurately.
Position(s) Applied For: Date of Application:
How did you learn about the company? (select one)
Last Name First Name Middle Name
Address 1
Address 2
City State Zip Code
Telephone Number(s)
Home: Work:
Are you available to work: If Part Time (Hours) If Temporary (Hours)
Are you available to work (circle): 1st Shift 2nd Shift 3rd Shift
On what date would you be available for work?
If you are under 18 years of age, can you provide required proof of your eligibility to work?
Have you ever submitted an application with the company before? If yes, please give date:
Have you ever been employed with the company before? If yes, please give date:
Are you currently employed? May we contact your present employer for references?
Are you legally qualified to work in the United States?
(Proof of citizenship or immigration status will be required upon employment.)
Have you ever been convicted of a crime other than a summary offense?
If yes, please explain:
EDUCATION
Elementary School High School Technical School College Other
School Name and
Location
Years Completed
Diploma Degree
Major Course(s)
of Study
Summarize special skills and
training not listed above:
Describe honors received:
Professional Licenses (include Type, State Issued, Date Issued, Expires On, and License Number)
and Certificates
List professional, trade, business, or civil activities and offices held. You may exclude memberships which may reveal
sex, race, religion, national origin, age, or disability or other protected status.
REFERENCES
Give name, address, and telephone number of three business references who are not related to you.
1.
2.
3.
EMPLOYMENT EXPERIENCE - Start with your present or most recent position.
1. Employer Dates Employed Job Title
Address From To
Telephone Number(s) Base Pay Supervisor
Start Final
Work Performed
Reason for Leaving
2. Employer Dates Employed Job Title
Address From To
Telephone Number(s) Base Pay Supervisor
Start Final
Work Performed
Reason for Leaving
3. Employer Dates Employed Job Title
Address From To
Telephone Number(s) Base Pay Supervisor
Start Final
Work Performed
Reason for Leaving
4. Employer Dates Employed Job Title
Address From To
Telephone Number(s) Base Pay Supervisor
Start Final
Work Performed
Reason for Leaving
SPECIAL SKILLS & QUALIFICATIONS
Summarize special job-related skills and qualifications acquired from employment or other experience.
Have you ever had any job-related training in the United States military? If yes, please give date:
Are you able to perform the essential requirements of the job?
If no, are there reasonable accommodations that can be made to allow you to perform the essential functions of the job?
State any additional information you feel may be helpful to us in considering your application.
I certify that the answers given herein are true and complete to the best of my knowledge. I also authorize investigation
of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
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 documentation 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 given in 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.
Initial Here (Required) Date:
Are you interested in joining the staff of Saxony Health Center?
Saxony offers a rewarding work enviroment where you can make a valuable contribution.
Please fill out the application below and submit it to our Human Resources Department.
We consider applicants for all positions on the basis of qualifications and without regard to
race, color, religion, sex, national origin, age, marital status, veteran status, disability, sexual
orientation, use of lawful products during non-work hours and any other legally protected status.
Saxony Health Center subscribes to a non-discrimination policy. We are an Equal Opportunity Employer(EOE).
RN Supervisor-Baylor: Full-time baylor position available. Experience in a long term care facility a plus! Includes shift differential, competitive wages and benefits. Must have a valid PA RN license.
Personal Care Aide: Full-time position available on the evening shift (2pm-10pm). Must enjoy working with the elderly, able to work independently, able to multi-task and be reliable.
Must have a high school diploma or equivalent.
Fill out the online application thoroughly. Or click here to download a printable version of this application.
