Thank you for considering Bickford Cottage or Bickford House. We are an equal opportunity employer. All applicants are considered for employment without regard to race, color, creed, national origin, sex, age, disability, veteran status or any other characteristic protected by law.
* required fields

Personal Data

Name*    
Current Address*
 
City* State* Zip*
Telephone (day)* (evening)*
Email Address*
Are you at least 18 years of age? Yes No
Are you legally authorized to work in the United States? Yes No
Have you even been convicted of a crime? Yes No
Bickford Senior Living Group will require proof of authorization to work in the United States as a condition of employment.

Job Interest


Position Desired*
Date Available
for Work
Employment Preference Full Time Part Time Temporary On Call
Shift Preference 7 AM - 3:30 PM 3:00 PM - 11:30 PM 11:00 PM - 7:30 AM Other:
Available Days Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Our residences operate 24 hours a day, 365 days a year. Are you available to work holidays? Yes No
How or by whom were you referred to us?*
Names of friends or relatives employed by
Bickford Senior Living Group (Cottages/Houses)
If applying for a position that requires driving or is
eligible for a company car, provide your license numberState
License #
Location of
Desired Building		 City* State*

Employment Eligibility

The Immigration Reform and Control Act of 1986 prohibits the employment of unauthorized aliens, and requires employers to verify the employment eligibility of all new employees. An offer of employment will be conditioned upon your providing the documentation required by law as evidence of your personal identity and your authorization to work in the United States.

Employment History

*Have you ever been employed by Bickford
Senior Living Group or one of its affiliates? Yes No		 Dates of
Employment
If yes, which business? Which Location?
*Are you currently subject to a non-compete or employment agreement with an employer? Yes No
Starting with your current or most recent employer, list all previous employers or provide a resume. Use the text field below if additional space is needed.
Company Name Job Title
Address Duties
  Start Date End Date
Phone # Start Salary End Salary
Name/Title of
Supervisor		 Reason for
Leaving
Company Name Job Title
Address Duties
  Start Date End Date
Phone # Start Salary End Salary
Name/Title of
Supervisor		 Reason for
Leaving
Company Name Job Title
Address Duties
  Start Date End Date
Phone # Start Salary End Salary
Name/Title of
Supervisor		 Reason for
Leaving
Additional History

References

  Reference Name Address Phone Number
1.
2.
3.

Applicant Release and Acknowledgement

I understand that Bickford Senior Living Group (hereafter referred to as the Company) requires certain information about me to evaluate my qualifications for employment and to conduct business if I become an employee. Therefore I authorize the Company to investigate my past employment, educational credentials and other employment related activities. I agree to cooperate in such investigations and release those parties supplying such information to the Company from all liability or responsibility with respect to the information supplied.

I agree that the Company may use the information it obtains concerning me in the conduct of its business. I understand that such use may include disclosures outside the Company in those cases where its agents and contractors need such information to perform their functions, where their company's legal interests and/or obligations are involved, or where there is a medical emergency involving me. I understand, however, that the Company intends to protect the confidentiality of personal information it obtains concerning me to the extent required by law.

I agree that I will not disclose or use while interviewing with or employed with Bickford Senior Living Group any confidential or proprietary information of others, including any former employer.

I understand that any employment with the Company is not for any fixed period of time and that, if employed, I may resign at any time for any reason, or the Company may terminate my employment at any time for any reason in the absence of a specific written agreement to the contrary. I understand that my employment-at-will status may not be modified or changed except in writing and signed by a duly authorized officer of the Company.

I understand that any false answers or statements made by me on this application, any supplement thereto or in connection with the above mentioned investigations may be grounds for refusal of employment, invalidate my employment or, if employed, will be the grounds for immediate discharge and render me ineligible for any Company benefits.

I acknowledge my agreement with the above and agree to complete any post-offer physical evaluations that the Company may require, including testing for illegal or unauthorized substances. I understand that any offer of employment is contingent upon my successfully passing the physical examination requirements and the background investigation.

*I acknowledge that I have read and understand the entire application.
 
Copyright © 2004 Eby Group