Careers – AMS Memorial Senior Living & Rehabilitation Center

Join our Team!

At AMS Memorial Senior Living & Rehabilitation Center, you will be a part of a team that believes each member is valuable. We are always looking for hardworking individuals who pride themselves on providing Quality of Life for our residents through exceptional care, dignity, respect, and compassion. If this sounds like you, we want to meet you!

Employment Application

Step 1 of 3 – Personal Information

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Your Personal Information

Your Name(Required)

First Last

Your Email Address(Required)

Your Phone(Required)

Address(Required)

Street Address City ZIP Code

Provide all previous names including maiden, married or aliases

Employment Information

Are you at least 18 years of age?(Required)

Yes

If younger than 16, can you furnish a work permit?

Yes

Have you ever been employed at this company before?(Required)

Yes

If yes, when?

MM slash DD slash YYYY

Are you employed now?(Required)

Yes

May we contact your present employer?(Required)

Yes

Can you, if hired, submit a verification of your legal right to work in the US?

Yes

On what date would you be available for work?

MM slash DD slash YYYY

Expected Salary(Required)

Are you available to work:(Required)

Full time

Part time

PRN

What days can you be available to work?(Required)

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Holidays

What shifts are you available for work?(Required)

Day

Evening

Overnight

Are you on a layoff and subject to recall?(Required)

Yes

Employment History

Do you have a record of founded child or dependent adult abuse or have you ever been convicted of a crime other than a simple misdemeanor offense relating to motor vehicles and laws of the road under chapter 321 or equivalent provisions, in this state or any other state?(Required)

Yes

If yes, please explain.

Are there currently any criminal charges pending involving you, or are you under investigation for child or dependent adult abuse?(Required)

Yes

If yes, please explain.

Have you ever been or are you currently excluded or debarred from participation in any Federal or State health care program, including Medicare and Medicaid?(Required)

Yes

If yes, please explain.

Have you ever had a professional license (including nursing, administrator, physician, therapy, social worker, dietician) that was revoked, suspended, or voluntarily relinquished?(Required)

Yes

Highest education completed(Required)

HS, including Diploma

Associate’s

Bachelor’s

Master’s

List any degrees obtained:

Do you hold any current license, registration, or certificate? If so, please list:

Have you ever had any disciplinary action against your license, registration, or certificate, including as a result of a finding of abuse, neglect, exploitation, mistreatment of residents or misappropriation of resident property?

Yes

Do you hold an educational honors, extra-curricular activities, professional societies or other information that you believe is related to your ability to perform the position for which you are applying and your application for employment?

Special skills and qualifications, including those acquired from employment or other experience.

Please list your Employment experience below starting with most recent. Please include Company name and telephone, employment dates, position held, job duties, and reason for leaving.

Please list any additional information you feel may be helpful to us in considering your application.

Please list 2-3 references. Please include their full name, phone number, email address, their relationship to you, and how long they have known you.

I hereby authorize release of the following information regarding my employment from my

Current Employers

Former Employers

Neither

By checking below I authorize the following information to be released

Employment dates

Position

Attendance

Salary

Performance

Eligibility for rehire

By printing my name below, I authorize the information above

Applicant’s Statement
Please read carefully before signing:
I certify that the answers given in this Application for Employment are true and complete to the best of my knowledge. The facility may investigate all statements made in the Application. The facility is required by law to check for any criminal or abuse record. I understand that any false or misleading information provided can result in a decision not to hire; immediate discharge if hired, and civil or criminal penalties in appropriate cases. In signing this Application, I state that I can complete job duties for the position in which I have applied. I understand that a job description will be given to me for review prior to being hired, and if hired, I am able to perform the job. I understand that failure to fulfill any aspect of the job may result in termination. I also understand that I am required to take a physical examination conducted by a licensed professional of the employer’s choosing after I am given a qualified offer of employment and that a health screening for diseases, such as TB, is required. I understand that this Application is not a contract of employment; that if hired, regardless of any oral representations to the contrary, the employment relationship between myself and the facility is terminable at will; that I have the right to terminate my employment at any time for any reason, and the facility retains the same right. Any changes to this employment relationship must be in writing. I understand that if hired, I am required to abide by all rules and regulations of the facility.

Equal Opportunity Employer
This facility is an equal opportunity employer. Employment decisions are made without regard to age, race, creed, color, sex, sexual orientation, gender identity, national origin, religion, disability, status as a disabled veteran, or other category as specified by law.

Applicant Name