PERSONAL INFORMATION

PERSONAL INFORMATION

APPLICANT QUESTIONS

APPLICANT QUESTIONS

include the date and final disposition of the case and the nature of the offense.
(a copy of job description is available upon request)

EDUCATION TRAINING

EDUCATION AND TRAINING

High School
College or Technical School
Other Schooling or Training

PROFESSIONAL LICENSES AND/OR CERTIFICATIONS

MILITARY RECORD

EMPLOYMENT HISTORY

LIST CURRENT (OR MOST RECENT) EMPLOYER FIRST

(Street, City, State, Zip Code)

LIST SECOND MOST RECENT EMPLOYER

(Street, City, State, Zip Code)

LIST THIRD MOST RECENT EMPLOYER

(Street, City, State, Zip Code)

REFFERENCES

REFERENCES

LIST THREE REFERENCES WHO ARE NOT RELATIVES OR FORMER EMPLOYERS

AVAILABILITY

Are you available to work:

Nazareth Home, Inc. does not discriminate in hiring or any other decision on the basis of race, color, sex, citizenship, national origin, ancestry, Vietnam era veteran status, or on the basis of age or physical or mental disability unrelated to ability to perform the work required. No question on this application is intended to secure information to be used for such discrimination.

I understand employment is at will and either party is free to terminate the employment relationship at any time without cause.
I also understand my employment may be terminated for any misstatement or omission of fact appearing on this application form.
If employed, I will be required to complete an Employment Verification Form (I-9), and within three (3) days show satisfactory evidence of identity and eligibility for employment.

PLEASE REVIEW AND SIGN WHERE INDICATED. In making application for employment:

  • I certify the information in this application is true and complete for all practical purposes. If employed, I understand that if it is later found that information on this application is false or incomplete that I could be subject to termination of employment without recourse.
  • I understand and agree that any employee handbook which I may receive will not constitute an employment contact, but is merely a statement of facility policies. I understand and agree that if I am offered employment by the facility, my employment will be for no definite term and that either I or Nazareth Home, Inc. will have the right to terminate employment at any time, for any reason and with or without notice. I also understand that this status can only be altered by a written contract of employment which is specific as to all material and terms and is signed by me and the CEO/Administration.
  • If hired, I agree to abide by all rules and policies of Nazareth Home, Inc. to include working reasonable overtime and holidays as required by departmental scheduling, the method and schedule for payment of earnings, and the dress code.
  • I understand that Nazareth Home, Inc. reserves the right to require its employees and new employees who have been given a conditional offer of employment to submit to blood tests or urinalysis for alcohol or drug screens, or to allow inspections of bags (including purses or briefcases) or parcels brought into or taken out of the facility. I understand that refusal to submit to a urinalysis, blood test or search when requested to do so may result in termination of employment.

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Nazareth Home

2000 Newburg Road
Louisville, Kentucky 40205
Contact Us:
(502) 459-9681

Nazareth Home Clifton

2120 Payne Street
Louisville, Kentucky 40206
Contact Us:
(502) 895-9425

©2018 Nazareth Home. All Rights Reserved.