Employment

Employment

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Kolob Care Employment Application

It is our policy to provide an equal employment opportunity to all qualified persons without regards to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental handicap, or veteran status.

Name:	First Last
Address
City, State, Zip
Telephone
Cell Phone
Social Security Number

Do you currently have a family member employed with Kolob Care?	Yes No
If yes who?
Position Applying For:
When can you Start?	Date:
Are you looking for:	Full Time Part Time
What hours are you available?
Are you willing to work graveyard shifts?	Yes No
Are you willing to work overtime?	Yes No

Have you ever been convicted of a felony?	Yes No
If yes, please fully describe the circumstances:
Education: School Name, Location, Year, Major or Degree
High School Name
Year Completed:
College, University, Vocational:
Other:
In addition to your work history, please list any skills, qualifications, or experience we should consider:
Employment History: (Start with your most recent employer)
Company Name:
Address:
Telephone:
Date Started:	End Date:
Starting Wage:	End Wage:
Name of Supervisor:	May we Contact? Yes No

Responsibilities:
Reason for Leaving

Company Name:
Address:
Telephone:
Date Started:	End Date:
Starting Wage:	End Wage:
Name of Supervisor:	May we Contact? Yes No
Responsibilities:
Reason for Leaving:

Company Name:
Address:
Telephone:
Date Started:	End Date:
Starting Wage:	End Wage:
Name of Supervisor:	May we Contact? Yes No
Responsibilities:
Reason for Leaving:

I certify that the facts set forth in this application are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. This company is hereby authorized to make any investigations of my prior educational and employment history. I understand that employment at this company is "atwill", which means that either I or this company can terminate the employment relationship at this time, with or without prior notice, and for any reason not prohibited by statue. All employment will continue on that basis. I understand that no supervisor, manager, or executive of this company, other than the president, has the authority to alter the foregoing.

Type in your full name as proof of your signature: