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Employment Application

Our application form is used to evaluate qualifications for determining the essential job functions for employment. Complete all sections of this application form. False or misleading information during the interview and/or on this application may be reasons for termination. Please notify the person that gave you the application form if you need any assistance in filling out the application form or have questions regarding the employment process. Every effort will be made to accommodate your needs in a reasonable amount of time.

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Qualified applicants will receive consideration without discrimination because of sex, marital status, race, age, creed national origin or disabilities as an equal opportunity employer.

PERSONAL INFORMATION
SALEM HOME POSITION
Shift(s) I am able to work...
Choose one:
EDUCATION
Choose the education level(s) you have completed
HIGH SCHOOL
COLLEGE / UNIVERSITY
TRADE SCHOOL / SPECIALIZED EDUCATION
PREVIOUS WORK EXPERIENCE
COMPANY / BUSINESS #1 (Most Recent)
COMPANY / BUSINESS #2
COMPANY / BUSINESS #3
REFERENCES

Give three references who are NOT relatives or a previous employer

REFERENCE #1
REFERENCE #2
REFERENCE #3
FINAL STEPS

If you are applying for an RN, LPN, CMA, CNA or other position requiring a license or registration number, please complete the following.

TERMS & CONDITIONS... I certify that I have read and understand the applicant note on this form and that the answers given by me to the forgoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions, or misrepresentations of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize Salem Home and/or its agents, including consumer reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information.

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Salem Home is a drug-free workplace. Applicants who have been offered a position with Salem Home must submit to a drug screen and criminal history background check prior to their first day on the job. All expenses incurred in the drug testing and background check will be the responsibility of Salem Home.

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Your employment with Salem Home is voluntarily entered into and you are free to resign at any time. Similarly, Salem home is free to conclude an employment relationship where it believes it is in the corporation’s best interest at any time. While we hope our relationship will be long and mutually beneficial, it should be recognized that neither you, nor Salem Home, have entered into any contract of employment, express or implied. Our relationship is and will always be one of voluntary employment.

Upload Resume or Supporting Documents (optional)

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We’ll review your application and contact you shortly.

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