Application for Employment
An Equal Employment Opportunity Employer
Education, Skills, and References
Describe your employment history.
Read the following before submitting your application.
Have you ever applied at or been employed by Sunny Oaks, Inc.?
Can you perform the essential functions of the job(s) for which you are applying with or without a reasonable accommodation?
How did you hear about us? (check all that apply)
If you have been referred by a Sunny Oaks, Inc. employee, they may be eligible for a referral bonus.
What kind of employment are you looking for?
What shift are you available to work?
May we contact your present employer?
Are you 18 years of age or older?
Are you currently authorized to work in the United States?
Do you have a valid driver's license or state issued ID card? (We will conduct a check of your driving record.)
Have you ever been the subject of a Protective Services investigation where there were substantiated charges of abuse or neglect?
(Please note that a "Yes" answer will not automatically bar you from consideration for employment. This depends on the type of substantiated charge.)
Highest Grade Completed
If not a high school graduate, do you have a GED certificate?
Special Skills, Qualifications, and Considerations
List three non-relative individuals not otherwise listed who are familiar with your qualifications and actual work history and ability. Include your reference's name, occupation/relationship, years known, telephone number (with area code), and city.
Start with your present or last job. List your last 3 jobs in order. Do not leave out any job. If you need more space, please enter it into the box at the bottom of the page. Be sure you list enough experience to qualify for the position for which you are applying.
History 1 (Current or Most Recent)
Please Review the Following
PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY. ONLY THOSE APPLICATIONS THAT ARE COMPLETE ARE CONSIDERED VALID. IF YOU HAVE ANY QUESTIONS REGARDING THIS STATEMENT, PLEASE CONTACT US. I certify that all answers and statements I have made on this application (and resume or other materials) are true and complete without omissions. I understand that any false information will be grounds for refusal to hire or for immediate discharge if I am employed. I authorize, without reservation, any of the persons or organizations named in this application, any law enforcement agency, administrator, state agency, institution, insurance company or agent for this organization, information service bureau or employer contacted by us, to give you complete information and records regarding my employment, education, character, motor vehicle operation history and qualifications.
I understand that a criminal records check WILL be conducted on me.
I further acknowledge that a telephonic facsimile (FAX) or photographic copy of documents shall be as valid as the original. This release includes all state and federal agencies.
I understand that if I am hired, my employment will be on an at-will basis. I recognize that if I am hired, my employment can be terminated at any time, with or without notice, for any reason not prohibited by law.
I also understand that no representative of this organization has any authority to enter into any employment agreement for any specified period of time, or to assure me of any future position, benefits, or terms and conditions of employment, except the Director, and then only in writing.
I have read, understand, and agree with the above.
Application for Employment Addendum
Have you ever been found to have to have committed abuse? Please check YES or NO for each of the following descriptions.
Caused physical injury to an adult or elderly person by non-accidental means
Caused physical injury to an adult or elderly person by means which appeared to be at variance with the explanation given of the injury
Willfully inflicted physical pain or injury upon an adult or elderly person
Failed to provide the care, supervision or services necessary to maintain the physical and mental health of an elderly person or a person with a developmental disability that may have resulted in physical harm or significant emotional harm to the elderly person
Failed to make a reasonable effort to protect an elderly person or a person with a developmental disability from abuse
Withheld the services necessary to maintain the health and well-being of an adult which led to the physical harm of an adult
Abandoned, including deserted or willfully forsaken an elderly person or a person with a disability, or withdrew or neglected duties and obligations owed to that person
Threatened significant physical or emotional harm to an elderly person or a person with a developmental disability through the use of derogatory or inappropriate names, insults, verbal assaults, profanity or ridicule
Threatened significant physical or emotional harm to an elderly person or a person with a developmental disability through the use of harassment, coercion, threats, intimidation, humiliation, mental cruelty or inappropriate sexual comments
Wrongfully took the assets, funds or property belonging to or intended for the use of an elderly person or a person with a developmental disability
Alarmed an elderly person or a person with a developmental disability by conveying a threat to wrongfully take or appropriate money or property of the person if the person would reasonably believe that the threat conveyed would be carried out
Misappropriated, misused or transferred without authorization any money from any account held jointly or singly by an elderly person or a person with a developmental disability
Failed to use the income or assets of an elderly person or a person with a developmental disability effectively for the support and maintenance of the person
Engaged in sexual contact with an adult or elderly person who did not consent or was considered incapable of consenting to a sexual act
Sexually harassed, sexually exploited or inappropriately exposed an adult or elderly person to sexually explicit material or language
Engaged in sexual contact with an adult or elderly person served by a facility or caregiver while working as an employee of the facility or caregiver
Any sexual contact between an elderly person and a relative of the elderly person other than a spouse
Engaged in sexual contact achieved through force, trickery, threat or coercion
Other Abusive Conduct
Involuntarily secluded an elderly person or a person with a developmental disability for your own convenience or the convenience of another caregiver
Involuntarily secluded an elderly person or a person with a developmental disability for purposes of discipline
Physically or chemically restrained an elderly person or a person with a developmental disability, excluding an act of restraint prescribed by a licensed physician and any treatment activities that are consistent with an approved treatment plan or in connection with a court order
Committed an act against an elderly person or a person with a developmental disability that constitutes a crime
Caused the death of a person 18 years of age or older, who had a developmental disability and was receiving services from a community program or facility or was previously determined eligible for services as an adult by a community program or facility, by other than accidental or natural means
Caused the death of a person 18 years of age or older, with a mental illness who was receiving services from a community program or facility, by other than accidental or natural means
Please Read the Following
I understand that if I am employed, any misrepresentation or material omission made by me on this addendum will be sufficient cause for cancellation of this application and immediate discharge from the employer's service, whenever it is discovered. I give the employer the right to contact and obtain information from all references, employers, educational institutions, and to otherwise verify the accuracy of the information contained in this addendum. I hereby release from liability the employer and its representatives for seeking, gathering, and using information and all other persons, corporations, or organizations for furnishing such information. If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This addendum does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no representative of the employer, other than an authorized officer, has the authority to make any assurances to the contrary. I further understand that any such assurances must be in writing and signed by an authorized officer.