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Grand View's Location

620 Grand View Ave
Blair, WI 54616

Phone: 608.989.2511

Click for driving directions
 

Please fill out the below application and press "submit."


APPLICATION FOR EMPLOYMENT
Grand View Care Center

Qualified applicants receive equal consideration. No question is asked for the purpose of excluding any applicant due to race, creed, color, national origin, religion, age, sex, handicap, veteran status, martial status, or any other characteristic provided by the law. WE ARE AN EQUAL OPPORTUNITY EMPLOYER AT WILL.
Applications are kept on file for six months. If after six months, you would still wish to be considered for employment it will be necessary for you to fill out a new application. A criminal background check is completed on all job applicants.

Date:
Last Name:
First Name:
Middle Name:
Address 1:
Address 2:
City:
State:
Postal Code:
Phone Number:
Email Address:
Type of work for which you wish to be considered:
1.)  
2.)  

Time    Part Time    Temporary    On Call   

What shift would you work? (Indicate order of preference.)

Day    PM    Night 

What source led you to apply here:

Education

High School
Name: Address:
Last year completed: Did you graduate?:

College
Name: Address:
Last year completed: Degree:
Major:

Technical School
Name: Address:
Months Attended: Degree:
Major:

If a Certified Nursing Assistant, are you registered with the State of Wisconsin? Yes No N/A

If a Registered or Licensed Practical Nurse, do you have a Wisconsin License? Yes No N/A

Employment History (List present or most recent employer first)

Employer:
Address:
City:
State:
Postal Code:
Phone:
Email:
Name of Supervisor:
Work Performed:
Employed from:  (mo/yr)  To:  (mo/yr)
Last Salary:
Reason for leaving:
Employer
Employer:
Address
City:
State:
Postal Code:
Phone:
Email:
Name of Supervisor:
Work Performed:
Employed from:  (mo/yr)  To:  (mo/yr)
Last Salary:
Reason for leaving:
Employer
Employer:
Address:
City:
State:
Postal Code:
Phone:
Email:
Name of Supervisor:
Work Performed:
Employed from:  (mo/yr)  To:  (mo/yr)
Last Salary:
Reason for leaving:

Personal Information

Are you a United States Citizen? Yes No
If no, type of visa?
Explain any personal, physical, or mental limitation(s) which may affect your ability to carry out the complete job responsibilities of the position you are applying for:  Emergency contact other than a household member:

Name:
Address:
City:
State:
Postal Code:

Have you ever served in the United Stated Armed Forces?
Yes No
Date of service:  (mo/yr)  To:  (mo/yr)
Briefly describe the skills you acquired while active duty:

Have you ever been convicted of a felony?   Yes No
If yes, give details:

With what computer programs are you familiar?

Any other office equipment?

Typing speed: wpm
Do you have any other skills and certificates that you wish to mention?

Reference 1
Name:
Address:
City:
State:
Postal Code:
Phone:
Email:
Reference 2
Name:
Address:
City:
State:
Postal Code:
Phone:
Email:


I understand that nothing contained in the employment application or in the granting of an interview is intended to create an employment contract between Grand View Care Center and myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon Grand View Care Center unless made in writing. I understand that no employer, manager, or other agent of Grand View Care Center, other than the appropriate department supervisor or the Administrator has any authority to enter into any employment agreement. I certify that the information contained in this application is correct to the best of my knowledge and understand that concealment or falsification of this information is grounds for immediate dismissal or nonhire. I authorize the references listed above to give Grand View Care Center any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and I release all parties from liability for any damage that may result from furnishing same to Grand View Care Center. I understand that my employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of Grand View Care Center or myself.

By checking here I certify I have read and understand the above.

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