Application - The Village Life Center

Have you ever been employed by this company? Yes No

Are you currently employed? Yes No

May we contact our present employer? Yes No

Are you prevented from lawfully being employed in this country? Yes No

Can you perform the main functions of the job? Yes No

Have you been convicted of a felony? Yes No

Are you available to work? Full Time Part Time

For which schedules are you available? Day Time Evening Time Night Time Weekdays Weekends

Equal Opportunity/Affirmative Action Employer

The Village Life Center, LLC is an equal opportunity employer. All applicants will be considered without regard to age, color, national origin, religion, sex, or other protected status in accordance with applicable federal and state equal employment opportunity laws.

Education

Special Skills, Qualifications, and Considerations

Summarize special skills and qualifications; volunteer activities, military experience, employment, or other activities related to the job you are seeking (i.e. typing speed, computer skills, driving, experience, etc.):

References

List three non-relatives who are familiar with your qualifications and actual work history and ability.

Employment Experience

Start with your present or last job. List your last four jobs is order. Do not omit any job.

Please account for all periods of unemployment, including, military experience. Include any volunteer work that relates to the position for which you are applying.

Please read the following statements carefully before signing this application. Only those applications that are signed and dated are considered valid. If you have any questions regarding this statement, please ask them before signing.

I certify that all answers and statements I have made on this application are true and complete without omissions. I understand that any false information will be grounds for refusal to hire or for immediate discharge if I am employed. I authorize the company to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies or organizations and law enforcement agencies to give you complete information and records regarding my employment,, education, character, and qualifications, and hereby release any said persons, schools, companies, or organizations and law enforcement agencies from any liability for any damage whatsoever for providing this information.

I understand that the use of illegal drugs and alcohol is prohibited during employment. If company requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.

I will be responsible for familiarizing myself with all rules and regulations of the company as they presently exist or are later modified. I understand that employment at this company is "at-will," which means that either the company or I can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis.

I also understand that no representative of the company has any authority to enter into any employment agreement for any specified period of time, or to assure me of any future position, benefits, or terms and conditions of employment, except as specifically stated in a current written agreement signed by the president of the company.

I have read, understand and agree with the above:

Application for Employment

Equal Opportunity/Affirmative Action Employer

Education

Special Skills, Qualifications, and Considerations

References

Employment Experience