Received Upon Completion for College/University
Professional/Trade School Name
Year Completed at Professional/Trade School
2. Reason for leaving
What are your Salary requirements?
If yes, may we contact your current employer?
Have you ever worked under another name?
Position Applying For:
RN/LPN/CMA/CNA License #
Are you currently employed
Are you prevented from lawfully becoming employed in this country because of visa or immigration status? (Proof of citizenship or immigration status will be required upon employment)
City, State, Zip Code:
I authorize Sunset Home, Inc. to verify my references and employment history.
1. Dates Employed
1. Work Performed
1.Reason for leaving
Are you available to work
On what date would you be available to work?
Have you ever been convicted of a felony or misdemeanor?
If yes, please list (information used for reference check)
Have you previously been employed with our company?
Residential Health Care
Westview on 8th
Received Upon Completion of High School
3. Starting/Ending Wage
3. Work Performed
2. Dates Employed
If yes, please explain
Online Employment Application
Sunset Home Inc.
MAKE SURE ALL BOXES ARE FILLED IN CORRECTLY OR APPLICATION WILL NOT BE SUBMITTED!
Describe Course of Study:
References-Give name, address, and telephone number for three references (for example: managers, teachers, co-workers)
3. Reason for leaving
1. Starting/Ending Wage
Special Skills and Qualifications
2. Starting/Ending Wage
Sunset Home Inc. does not discriminate in hiring or any other decision on the basis of race, color, sex, citizenship, national origin, ancestry, or on the basis of age or physical or mental disability to perform the work required. No question on this application is intended to secure information to be used for discrimination. It is understood and agreed that any misrepresentation by me on this application will be sufficient cause for cancellation of this application and/or separation from employer’s service if I have been employed. Furthermore, I understand that, just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time, without cause and without prior notice. I voluntarily give this institution the right to make a thorough investigation of my past employment and activities, agree to cooperate in such investigation and release from all liability or responsibility all persons, companies or corporations supplying such information. I consent to take the pre-employment physical and/or examination as may be required by this home at such times and places as the home shall designate. If employed, the Sunset Home Inc. reserves the right to test me for the presence of drugs in compliance with the home’s substance abuse policy. If employed, I will be required to complete an Employment Verification Form (I-9), and within in three days show satisfactory evidence of identity and eligibility for employment. I understand and consent to the new pre-employment laws requiring Sunset Home Inc. to request a criminal background check and agree to fill out the accompanying form providing all aliases I have been known under. Sunset Home Inc. is conditionally employing pending the results of the criminal background check. I also have the right to access the Kansas Department of Health and Environment who provides the information of the background check. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. If my position requires a current Kansas license or certification, I understand I must provide a copy for my personal record.
Received Upon Completion
3. Dates Employed
1. Job Title
Use this space to state any additional information you feel may be helpful in considering your application
High School Name
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