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Thank you for your interest in joining our team. Please complete the application below and a member of our staff will be in touch shortly.
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Full Name
E-mail Address
Phone
Street Address
City, State, Zip
Are you a US Citizen?
Yes
No
Have you ever been convicted of a felony?
Yes
No
Desired Position
CNA
Resident Assistant
Dietary Aide
Cooking
Housekeeping
Maintenance
Driver
Shift Desired
Days
Evenings
Nights
Hours Desired
Part-Time
Full-Time
PRN
Name of High School and Graduation Year
College/Trade School Name and Location
College Degree/Certificate Earned and Year of completion
Present Employer and Phone Number
May we call current employer?
Yes
No
PERSONAL REFERENCE
EMPLOYMENT HISTORY
Available Start Date
AUTHORIZATION TO RELEASE INFORMATION: If I am given a conditional offer, I authorize Eastland to make a complete investigation of me, including, but not limited to, my past employment history, medical history, criminal activity, motor vehicle driving records, and worker's compensation history. I authorize all persons and organizations to release any information concerning my background and hereby release all persons from liability for any damage whatsoever for issuing this information. I acknowledge that a telephone facsimile or photographic copy shall be valid as the original. I understand that this employment application and any other employee-related documents are not contracts of employment; that any individual who is hired may voluntarily leave employment upon proper notice and may be terminated by the employer at any time and for any reason.
I AGREE