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Click Here To Download Our Application For Employment (.PDF file)

fax this application to

478-474-4473

Incomplete Applications Will Not Be Processed.     Full Name Address City State Choose a State Outside US / Canada Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory Zip E-mail Home Phone
Position Applying For (first choice)
Experience?* yes no Will You Accept Temporary Work?* yes no
Position Applying For (2nd choice)
Experience? yes no Will You Accept Temporary Work? yes no
How many man hours can you work weekly? Shift and/or hours desired
Can you safely perform the essential functions of the position in which you are applying? If No, Explain Are you a United States citizen or legal Alien with rights to work on the job in which you are applying? yes no Have you since the age of 18, Ever been convicted of a felony? yes no If yes, please give dates
Education Information High Education Diploma/Technical School Major Major Address Address City City Number Of Years Number Of Years Did You Graduate did you graduate? yes no Did You Graduate did you graduate? yes no         College/University Graduate School Major Major Address Address Number Of Years Number Of Years Did You Graduate did you graduate? yes no Did You Graduate did you graduate? yes no
References (Give Names of Persons we may contact to verify your qualifications for the position) Reference 1 Name Reference 2 Name Address Address Phone Phone         Reference 3 Name Reference 4 Name Phone Phone
Employment (Give a complete record of all employment and reasons for periods unemployed during past 10 years. Start with most recent employment. Give United States Experiences only.)     Employer 1 Address City State Choose a State Outside US / Canada Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory Zip   Supervisor Name Supervisor Phone Start Date End Date Position Avg Hours Per Week Reason For Leaving         Employer 2 Address City State Choose a State Outside US / Canada Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory Zip   Supervisor Name Supervisor Phone Start Date End Date Position Avg Hours Per Week Reason For Leaving         Employer 3 Address City State Choose a State Outside US / Canada Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory Zip   Supervisor Name Supervisor Phone Start Date End Date Position Avg Hours Per Week Reason For Leaving         Employer 4 Address City State Choose a State Outside US / Canada Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory Zip   Supervisor Name Supervisor Phone Start Date End Date Position Avg Hours Per Week Reason For Leaving

I authorize the investigation of my background including all information contained in this application and information provided in the interview. I understand that misrepresentation or omission of information in connection with applicant and interview will be sufficient cause, in and of itself for rejection or dismissed whenever discovered. I understand and agree that any offer of employment is contingent upon satisfactory completion of  Angels Of Mercy employment investigation on which includes but is not limited to health assessment, criminal history check educational and work verification, reference checks, consumer report and any investigation required by local, state or federal laws. I understand that if I am hired by Angels Of Mercy, my employment will be for an indefinite period of time and will be “at will” which means either Angels Of Mercy or I may terminate the employment relationship at anytime and for any reason or no reason.

I further understand that if hired, my at-will employment status may only be changed in written contract signed by management of Angels Of Mercy and that no representative of Angels Of Mercy has the authority t make oral promise to me concerning my employment. Finally, I also understand that Angels Of Mercy may adapt from time to time, policies or handbooks dealing with benefits and other terms or conditions of employment. These policies or handbooks do not constitute a contract of employment between Angels Of Mercy and me. Angels Of Mercy reserves the right to change or discontinue these policies and/or handbooks at any time with or without notice to me.

Angels Of Mercy strives to provide a safe healthy and productive work environment and supports a smoke free alcohol-free work environment.

 

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