Orchard View Manor: Employment Application

Home About Orchard View Our Services Careers Contact Us Activities Calendar EMPLOYEES

Please use the form below to apply for a position at Orchard View Manor. Remember to be as accurate as possible with all the information you supply. If your qualifications match one of our openings, we will contact you. Thanks for your interest in Orchard View Manor.

Last Name, First Name:	,
Email Address:
Home Phone:	Cell Phone:
Street:	City: State: Zip:
Position Desired:	Date Available:
Job Type:	\| Shift: \| Desired Salary:
Are you licenced for the job for which you are applying? Licence Number: Expiration Date:
Has your professional license ever been revoked, suspended, or been on probation? If yes, explain:
Note any skills, experience, or other qualifications which you feel are appropriate to the position for which you are applying:
Are you able to perform the essential duties of the position for which you are applying with or without reasonalble accomodations?
Have you ever been convicted of resident abuse (Verbal, Physical, Mental, Sexual)?
Have you ever been convicted of a felony or misdemeanor? If yes, explain:
Have you ever been employed by this facility in the past?
Do you have any friends or relative employed by OVM? If so, whom?
Are you a US citizen or otherwise lawfully permitted to work in the US?
How did you learn of Orchard View Manor (friend, newspaper, walk-in, etc.)?
Orchard View Manor is subject to the provisions of the RI Workers Compensation Act and provides all employees with coverage.

Educational History
Type of School	Name of School, Location	Last Year Attended	Degree or Certification
High School		9 \| 10 \| 11 \| 12
College		1 \| 2 \| 3 \| 4
Graduate School		1 \| 2 \| 3 \| 4
Other

Employment History
List below all present and past employment starting with your most recent.
Name of Company	Street, City, State, Zip ,	Telephone
Name of Supervisor	Job Title	Dates employed to
Beginning/Ending Salary /	Reason for Leaving	May we contact?

Name of Company	Street, City, State, Zip ,	Telephone
Name of Supervisor	Job Title	Dates employed to
Beginning/Ending Salary /	Reason for Leaving	May we contact?

Name of Company	Street, City, State, Zip ,	Telephone
Name of Supervisor	Job Title	Dates employed to
Beginning/Ending Salary /	Reason for Leaving	May we contact?

Name of Company	Street, City, State, Zip ,	Telephone
Name of Supervisor	Job Title	Dates employed to
Beginning/Ending Salary /	Reason for Leaving	May we contact?

Orchard View Manor is an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, national origin, age, disability or any other legal characteristic. All candidates tentatively selected for employment will be required to sign a release for the purposes of conducting a criminal records check prior to employment.

I understand that misrepresentation or omission of facts on this application may be cause for denial of employment of dismissal. I also understand that employment, if offered is for no definite period and may be terminated either by myself or the facility. continued employment is contingent upon successful completion of the qualifying period which is the first 90 calendar days of employment.