Join Our Care Team | Careers in Assisted Living, Memory Care

Date:

Position Desired:

Location: *

Mankato

Jordan

Le Sueur

First Name:

Middle Name:

Last Name:

Address

City

State/Province

Zip/Postal

Phone Number (primary) *

Email address where you can be reached:

Are you of legal age to work?

Yes

No

Do you have the legal right to be employed in the United States?

Yes

No

If offered a position, the Immigration Reform and Control Act of 1986 requires you to furnish proof of your employment authorization and your identity before you can begin work.

Range of pay expected: $

Have you ever been employed by Oak Terrace?

Yes

No

If yes, when?

Amount of hours you desire to work each week?

If your application is considered favorable, on what date will you be available to work?

RNs, LPNs, and CNAs please provide current professional license (if applicable) and when it expires:

Current State Professional License Number:

Expiration Date:

WORK HISTORY

Please list three of your previous work experiences, beginning with the most recent:

Name, Address, Supervisor Contact Information and Position Held

May we contact your present employer?

Yes

No

If there is a particular employer(s) you do not wish us to contact, please indicate which one(s) below:

Name of current employee:

If other, please specify:

APPLICANT’S CERTIFICATION AND AGREEMENT

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize Oak Terrace Health Care to make an investigation of any of the facts set forth in this application. This Application for Employment is not a contract and cannot create a contract. If employed by Oak Terrace Health Care, I agree to abide by it’s policies and procedures. I understand that my employment at Oak Terrace Health Care is “at will”, which means either I or Oak Terrace Health Care can terminate the employment relationship at any time, with or without prior notice, with or without cause for reason not prohibited be statute. I understand that any offer of employment made to me is conditional until I successfully complete the fit to work screen, drug testing, background check and provide proof that I may legally be employed in the United States. I understand that if I am employed that emergency conditions may require me to temporarily work shifts other than the one for which I am applying and agree to such scheduling change as directed by my department manager. I understand that this Application for Employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I certify that I have read and agree to the above Applicant's Certification and Agreement.

Signature

Clear

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RNs, LPNs, and CNAs please provide current professional license (if applicable) and when it expires:

WORK HISTORY

APPLICANT’S CERTIFICATION AND AGREEMENT

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