Be a Part of Our Caring Team at Monark Grove Madison, AL! Job Application Monark Grove MadisonPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.About You - Step 1 of 6Job InterestYour Name *FirstLastYour Phone *Your Email *I prefer to be contacted: *By phoneBy emailCurrent Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmergency Contact Name and NumberAre you over 18 years of age? *YesNoIf yes, can you provide proof of employment eligibility?YesNoIf hired, are you able to furnish proof that you are legally qualified to work in the United States? *YesNoDo you have a valid driver's license? *YesNoTo comply with the Immigration Reform and Control Act of 1986, if you are hired you will be required to provide documents to establish your identity and your authorization to be employed in the United States. Such documents will be required within the first three business days following your hire, or upon your first work day if your employment period will be less than three days.If yes, license number/issuing state:How did you find out about this employment opportunity?Type of employment desired: *Fulltime (32 hrs/week or more)Part-time (less than 32 hrs/week)What shifts are you available? Are there days or times when you are unable to work or prefer to not work? How many hours would you like to work per week? Please explain. *Are you able to perform the functions of this job, with or without reasonable accommodation? *YesNoNextHave you ever been convicted of a crime? *YesNoIf yes, please explain.Are you currently awaiting trial or sentencing for any criminal offense, or have you ever initiated an act of violence in the workplace? *YesNoIf yes, please explain.BackNextHigh School/GEDHigh School/GED (Name and Location): *Number of years completed: *Did you graduate? *YesNoCollege/UniversityCollege/University (Name and Location):Degree/Major:Number of years completed:Did you graduate?YesNoAdditional EducationAdditional Education or Other (Name and Location):Degree/Major:Number of years completed:Did you graduate?YesNoHighest degree earned:High School/GEDAssociateBachelorMasterDoctorateSkillsProfessional Licensures/CertificationsEnter License Type, Issuing State, License Number and Expiration Date.Note: If you are hired for a position that requires state or national registration or certification, you must furnish Atlas Senior Living with current proof of certification or registration. Skills & QualificationsPlease list unique job-related skills and qualifications acquired from current/previous employment or other experiences.BackNextPlease specify your complete full-time and part-time employment history, including self-employment. Begin with your most recent employer. All employers including your current employer may be contacted to verify the information you provide.May we contact your current employer prior to an offer of employment? *YesNoEmployer 1Employer Name: *City/State:Supervisor's Name:Supervisor's Title:Supervisor's Phone:Employed from: *Employed until:Starting Salary:Ending Salary:Your Position and Job Responsibilities:Reason for Leaving:Current EmployerThis is my current employerEmployer 2Employer Name:City/State:Supervisor's Name:Supervisor's Title:Supervisor's Phone:Employed from:Employed until:Starting Salary:Ending Salary:Your Position and Job Responsibilities:Reason for Leaving:Employer 3Employer Name:City/State:Supervisor's Name:Supervisor's Title:Supervisor's Phone:Employed from:Employed until:Starting Salary:Ending Salary:Your Position and Job Responsibilities:Reason for Leaving:BackNextPersonal ReferencePlease list a personal mentor or friend that is qualified to give an opinion of your character, work ethic, and/or reliability. Please do not include a spouse or family member as this reference.Name *Relationship *Phone *How do you know this person and how long have you known this person? *BackNextAtlas Senior Living is an Equal Opportunity Employer This application us not complete until it is fully competed, signed and all statements below have been read. Your signature confirms all statements below are accurate: I certify that all of the information furnished on this application and during the application process is true, complete and to the best of my knowledge. I understand that any misrepresentation or omission of facts called for may result in refusal to hire or, if hired, may result in my dismissal at any time regardless of when the false answer or omissions are discovered. I recognize that this employment application is not an offer of employment. I agree that if I am hired by the Company, I will be an at-will associate, meaning that either the Company or I may end the employment relationship at any time with or without cause or notice. I further understand and agree that, except for employment-at-will status, if hired my wages, hours, working conditions, job assignment(s) and compensation rate(s) will be subject to change by the Company. I understand that if I am offered employment, I may be required to sign a non-solicitation and non-disclosure agreement, as a condition of the employment. I hereby authorize Atlas Senior Living to conduct any necessary investigation regarding my background as it relates to the position I am seeking and to the extent permitted by federal, state and local laws. I agree to complete the requisite authorization forms for the background investigation. I hereby release all parties from any liability in connection with the provision and use of such information. I agree to submit to legally permissible drug testing upon an offer of employment from Atlas Senior Living and prior to starting work. I agree that any offer of employment is contingent upon my receiving a negative test result. I understand and expressly agree that if employed by Atlas Senior Living, storage areas provided for me (locker, desk, etc.) are open to investigation by the Company without prior notice to me. I agree to undergo a pre-employment physical examination consistent with federal and state law. By executing and submitting this application, I certify that I am genuinely interested in working in the position(s) for which I have applied and am making this application for no other purpose. I understand that by signing this application, I agree that in the event a dispute should arise with regard to whether or not I am hired, or if hired, a dispute should arise between my employer and me, that I agree to arbitrate the dispute by a final binding arbitration. The cost of the arbitration shall be paid for by the employer to the extent the costs are awarded by the arbitrator, and therefore, I may have to pay some of the costs. I agree to paying the portion the arbitrator requires. The arbitration to which I am party to is governed by the employer’s policy with regard to binding arbitration, and the employer has provided me with a copy of that policy. My signature below certifies that I agree to be bound by the terms and conditions stated in this application, which contains all the understandings between Atlas Senior Living and me concerning the topics addressed herein, and supersedes any prior inconsistent understandings between Atlas Senior Living and me on such issues.I have read and understand the above disclosure *YesApplicant Name *Date *cc_checkSubmit