Employment Application

Fredonia Place is an equal opportunity employer and does not discriminate against applicants based on any protected characteristics, including, but not limited to, race, ethnicity, color, national origin, religion, age, sex, sexual orientation, gender identity, family status, disability, medical or genetic condition or any other basis protected under federal, state or local law.
Applying for which Location: *
Are you able at the time of employment to submit verification of your legal right to work in the U.S.? 
(Verification and completion of Form I-9 must be submitted no later than three business days after date of hire.): *
Are you under the age of 18? If so please bring the necessary work certificate at the time of interview. *
Type of Employment Desired? *
Are you willing to work overtime? *
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Have you ever applied at Fredonia Place before? *

Education

Please tell us about your Education. *
 High SchoolCollegeOther
Education
Course of Study
Graduate?
# of Years Completed
Degree/Major

Work Experience (Start with your present or last place of employment. You may include any verifiable work performed on a volunteer basis, internships, or military service.)

Employer #1

May we Contact? *

Employer #2

May we Contact? *

Employer #3

May we Contact?

References (Please list the names of additional work related references we may call. Individuals with no prior work experience may list school or volunteer related references.)

Please Provide Information for References:
 Reference #1Reference #2
Name
Position
Company
Work Relationship
Telephone Number

QUESTIONS

What experience have you had in long term care? *
What is most important to you in a position? *

RESUME UPLOAD


APPLICANT CERTIFICATION

I understand and agree that if driving is a requirement of the job for which I am applying, my employment and/or continued employment is contingent on processing a valid driver’s license and automobile liability insurance in an amount equal to the minimum required by the state I reside.

I understand that Fredonia Place is a drug-free workplace and has a drug-testing program consistent with applicable federal, state, and local law. Since Fredonia Place has a drug-testing program and if I am offered a conditional offer or employment, I understand that if a pre-employment (post-offer) drug test is positive, the employment offer may be withdrawn. I agree to work under the conditions required by Fredonia Place that are consistent with federal, state, and local law. I also understand that all employees, pursuant to Fredonia Place’s policy and federal, state, and local law may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or controlled drugs. If employed, I understand that the taking of drug tests is a condition of continued employment and I agree to undergo drug testing consistent with Fredonia Place’s policies and applicable federal, state, and local law.

If employed by Fredonia Place, I understand and agree that Fredonia Place, to the extent permitted by federal, state, and local law, may exercise its right, without prior warning or notice, to conduct investigations of property (including, but not limited to, files, lockers, desks, vehicles, and computers) and, in certain circumstances, my personal property. I understand and agree that as a condition of employment and to the extent permitted by federal, state, and local law, I may be required to sign a confidentiality, non-compete, and/or conflict of interest statement. I certify that all the information on this application, my resume, or any supporting documents are complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal.


I UNDERSTAND THAT NEITHER THIS APPLICATION NOR ANY COMMUNICATION BY A MANAGEMENT REPRESENTATIVE IS INTENDED TO CREATE OR DOES CREATE A CONTRACT OF EMPLOYMENT, OFFER, OR PROMISE OF EMPLOYMENT. I ACKNOWLEDGE THAT IF HIRED BY THE COMPANY, EMPLOYMENT IS ON AN AT-WILL BASIS. THIS MEANS THE COMPANY IS FREE TO TERMINATE MY EMPLOYMENT AT ANY TIME, WITH OR WITHOUT CAUSE OR ADVANCED NOTICE, IN ACCORDANCE WITH STATE LAW, AND ACCEPTANCE OF EMPLOYMENT IS NOT A CONTRACT OF EMPLOYMENT FOR ANY SPECIFIED TIME. SIMILARLY, I AM FREE TO TERMINATE MY EMPLOYMENT WITH THE COMPANY AT ANY TIME FOR ANY REASON. THIS AT WILL PROVISION MAY BE MODIFIED OR WAIVED ONLY IN A WRITTEN AGREEMENT SIGNED BY AN AUTHORIZED REPRESENTATIVE OF THE COMPANY AND ME. I AGREE TO CONFORM TO THE RULES AND REGULATIONS OF THE COMPANY, AND I UNDERSTAND THAT THE COMPANY HAS COMPLETE DISCRETION TO MODIFY SUCH RULES AND REGULATIONS AT ANY TIME, EXCEPT THAT IT WILL NOT MODIFY ITS POLICY OF EMPLOYMENT AT WILL.

I authorize Fredonia Place or its agents to confirm all statements contained in this application and/or resume as it relates to the position I am seeking and to the extent permitted by federal, state, and local law. I agree to complete any required authorization forms for the background investigation. I authorize and consent to, without reservation any party or agency contacted by this employer to furnish the above-mentioned information. I hereby release, discharge and hold harmless, to the extent permitted by federal, state, and local law, any party delivering information to Fredonia Place or its duly authorized representative pursuant to this authorization from any liability, claims, charges, or causes or action, which I may have as a result of the delivery or disclosure of the above-requested information. I hereby release from liability Fredonia Place and its representative for seeking such information and all other persons, corporations, or organizations furnishing such information. 

YOU MUST COMPLETE THE ENTIRE APPLICATION AND ALL THE REQUIRED FIELDS BEFORE WE CAN PROCESS YOUR APPLICATION.

I understand Fredonia Place hires only individuals who are legally eligible to work in the United States. 

Applicant Signature: *
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Parent/Legal Guardian Signature:
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If the applicant is a minor, the foregoing release and consent must be signed by the applicant’s parent or legal guardian. Signature by the applicant’s parent or legal guardian constitutes acknowledgement by the applicant and the parent or legal guardian that Fredonia Place, to the extent permitted by federal, state, and local law, can test the applicant for controlled substances, conduct inspections of property without notice, and communicate screen results to Fredonia Place personnel who need to know, the applicant, and the applicant’s legal guardian.