Senior Resources

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone

Email

Are you prevented from lawfully becoming employed in this country because of Visa or immigration status?*

Yes
No

Are you 18 years or older?*

Yes
No

Have you ever applied for employment with us in the past?*

Yes
No

If yes, when and for what position(s)?

Have you ever been convicted of, or pled guilty or no contest to, any crime other than a minor traffic violation?*

Yes
No

If yes, please give details (A conviction does not necessarily prevent employment)

Have you ever been discharged or asked to resign from any job?*

Yes
No

If yes, please give details (A dismissal from a prior job will not necessarily prevent employment)

Do you have a valid SC driver's license or driver's license from another state?*

Yes
No

Are your driving privileges currently restricted or limited in any way?*

Yes
No

Do we currently employ any of your relatives?*

Yes
No

If yes, please list name(s) and position(s)

Summary of educational background*

School	Degree	Dates Attended

Summary of professional background*

List current/previous places of employment (with address), dates employed, job title, explanation of duties, supervisor name & contact information, reason for leaving.

Position applying for*

Senior Meals Assistant
Home Care Aide

You may select more than one.

Salary expected*

Date available to begin*

Please list days of the week and times you are available to work*

Consent Statement*

By submitting this form, I certify that the foregoing statements are true and complete to the best of my knowledge and belief. I hereby authorize the verification of all information set forth in this application for employment. I also authorize the review of my credit history, criminal record (if any), driving record and any other inquiries which may be necessary in arriving at an employment decision. I understand that any false, incomplete, or misleading information will be grounds for rejection of this application or, if subsequently discovered, grounds for termination. I understand that employment will be “at will,” which means that I may terminate the employment relationship at any time, with or without notice or cause, and the employer retains the same rights.

I Agree

Background Check Consent Statement*

Should I be employed by Senior Resources, Inc., I give Senior Resources, Inc. permission to conduct periodic reviews of my driving, criminal and background records, as necessary, during my period of employment. I also understand that, as a condition of employment, Senior Resources will conduct drug testing on all applicants and employees as outlined in the Employee Policy and Procedure Manual.

I Agree

Additional Comments or Information

Online Job Application