Application - Indiana Peaceful Residential Care

career form

Applicant Information

Name
Name
First
Last
Address
Address
City
State/Province
Zip/Postal
Are you authorized to work in the United States?
Do you have a valid Driver’s License?
Have you ever worked for Indiana Peaceful Residential Care before?
Have you ever been convicted of a felony?

Education

Graduate?
Diploma?
Address
Address
City
State/Province
Zip/Postal
Country
Graduate?
Address
Address
City
State/Province
Zip/Postal
Country
Graduate?
Address
Address
City
State/Province
Zip/Postal
Country

References

Name
Name
First
Last
Name
Name
First
Last
Name
Name
First
Last

Previous Employment

May we contact employer?
Address
Address
City
State/Province
Zip/Postal
Country
May we contact employer?
Address
Address
City
State/Province
Zip/Postal
Country
May we contact employer?
Address
Address
City
State/Province
Zip/Postal
Country

Military Service

Availability

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Disclaimer and Signature

Indiana Peaceful Residential Care is an equal opportunity employer. Indiana Peaceful Residential Care does not discriminate employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status, or unfavorable discharge from military service.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Indiana Peaceful Residential Care to hire me. If I am hired, I understand that either Indiana Peaceful Residential Care or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Indiana Peaceful Residential Care has the authority to make any assurance to the contrary.

I attest with my signature below that I have given to Indiana Peaceful Residential Care true and complete information on this application. No requested information has been concealed. I authorize Indiana Peaceful Residential Care to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

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