Wilson's Healthcare

Application for Employment

Please Answer All Questions. Resumes Are Not A Substitute For A Completed Application

I UNDERSTAND THAT NEITHER THIS APPLICATION NOR ANY COMMUNICATION BY A MANAGEMENT REPRESENTATIVE IS INTENDED TO CREATE OR DOES CREATE A CONTRACT OF EMPLOYMENT OFFER OR PROMISE OF EMPLOYMENT FOR A DEFINITE TERM. I ACKNOWLEDGE THAT IF HIRED BY THE COMPANY, EMPLOYMENT IS ON AT-WILL BASIS IN ACCORDANCE WITH STATE LAW. THIS MEANS THE COMPANY IS FREE TO TERMINATE MY EMPLOYMENT AT ANY TIME, WITH OR WITHOUT CAUSE OR ADVANCE NOTICE. IN ACCORDANCE WITH STATE LAW, AND ACCEPTANCE OF EMPLOYMENT IS NOT A CONTRACT OF EMPLOYMENT FOR ANY SPECIFIED TIME. SIMILARLY, I AM FREE TO TERMINATE MY EMPLOYMENT WITH THE COMPANY AT ANY TIME FOR ANY REASON. THIS IS AT-WILL PROVISION MAY BE MODIFIED OR WAIVED ONLY IN A WRITTEN AGREEMENT SIGNED BY AN AUTHORIZED REPRESENTATIVE OF THE COMPANY AND ME. I AGREE TO CONFORM TO THE RULES AND REGULATIONS OF THE COMPANY, AND I UNDERTSAND THAT THE COMPANY HAS COMPLETE DISCRETION TO MODIFY SUCH RULES AND REGULATIONS AT ANY TIME, EXCEPT THAT IT WILL NOT MODIFY ITS POLICY OF EMPLOYMENT AT-WILL OR IT’S ARBITRATION POLICY, IF ANY.

We are an equal opportunity employer. Applicants are considered for positions without regard to race, religion, sex, national origin, age, disability, or any other consideration made unlawful by applicable federal, state, or local laws.

Position Applied For:

Name:

Telephone Number :

Alternate or Cellular Tel No. :

Present Address :

How long have you lived there :

Desired Salary/Hourly Rate :

If under the age of 18, can you produce the necessary work certificate at the time of employment?

Yes

Type of employment desired? :

Are you willing to work overtime?

Date on which you can start work if hired

Have you previously applied for employment with this Company

If yes, when and where did you apply?

Have you ever been employed by this Company?

Yes

If Yes, provide dates of employment, location, and reason for separation from employment.

INSTRUCTIONS FOR ANSWERING THE NEXT TWO QUESTIONS

1. Hawaii applicants: Do not answer the following two questions.

2. District of Columbia and Washington applicants: Limit any response to the past ten (10) years.

3. Utah applicants: Limit any response to felony convictions only

4. Arizona. District of Columbia, Illinois, Missouri, Rhode Island and Utah applicants: Do not respond to second question regarding Arrests

5. California applicants: Do not include misdemeanor marijuana-related convictions that are more than two (2) years old or Misdemeanor convictions for which probation was successfully completed or otherwise discharged and the case was judicially dismissed.

Massachusetts applicants: Limit any response regarding misdemeanor convictions to the last five (5) years and to those which were Not a first offense for drunkenness, simple assault, speeding, a minor traffic violation or disturbing the peace. Applicants with a sealed Record n file with the Massachusetts Commissioner of Probation may answer “No Record” with respect to: 1) all inquiries relating to prior convictions or arrests 2) misdemeanor convictions older than five (5) years: and 3 first time convictions for simple assault, drunkenness, speeding, minor traffic violations or disturbing the peace.

North Dakota and Oregon applicants: Regarding arrests, limit your response to pending charges that are less than one (1) year old. Indiana applicants: Regarding arrests limit your response to pending charges for felonies and class A misdemeanors that are less than one (1) year old. Michigan applicants: regarding arrests, limit your response to felony arrests awaiting conviction or dismissal.