Employment Application

Please list your last four (4) employers, assignments or volunteer activities, starting with the most recent including military experience. Explain any gaps in employment in comments section below.

In order to be considered for the position, applicants must complete all sections of the application, including all names, phone numbers, dates and salaries. Incomplete information will delay review of application.

Important: Please note that you have 1 hour to complete this application or your session will time out and your data will not be saved.

Position applied for:
Which residence are you applying for:
Name (First, Last, Middle Initial):
Email Address:
Home Phone Number:
Address:
City:
State:
Zip Code:
If necessary, the best time to call you at home is:
May we contact you at work?	YesNo
If yes, work number:
Best time to call at work:
If you are under 18, can you furnish a work permit?	YesNo
Have you filed an application here before?	YesNo
If yes, give dates	from: to:
Have you ever been employed here before?	YesNo
If yes, give dates	from: to:
Are you legally eligible for employment in this country? (Proof of U.S. citizenship or immigration status will be required upon employment)	YesNo
Date available for work?	--
Type of employment desired:	Full Time Part-Time Temporary Seasonal
Are you on a lay-off and subject to recall?	YesNo
Will you relocate if job required?	YesNo
Will you travel if job required?	YesNo
Will you work overtime if job required?	YesNo
Have you ever been bonded?	YesNo
Have you been convicted of a felony, misdemeanor or summary offense? (Such conviction may be relevant if job related, but does not bar you from employment.)	YesNo
Have you ever been convicted of a violent crime?	YesNo
Have you ever been dismissed from employment due to abuse of clients, residents, or patients?	YesNo
If yes to any of the last three questions, please explain in detail.
Do you have any friends or relatives working for IntegraCare Corporation or any ICC owned or managed residence?	YesNo
If yes, please list name(s) and relationship?
Driver's license number (If required by job)
Driver's license state

Employment

Online Application Form