BAFILIVE - Careers at BAFI

Which Center? *

Which Category? *

YOUR INFORMATION

1. First Name *

2. Last Name *

3. Address *

4. City *

5. State *

6. Zip *

7. Phone *

8. Email *

9. Are You 18 Year Old? *

10. Are you a US citizen or do you have a green card? *

11. Have you ever been convicted of a felony? *

12. Have you ever been convicted of abuse, neglect or exploitation of the elderly? *

EMPLOYMENT DESIRED

13. What position are you appling for? *

14. What is your soonest possible start date? *

15. Desired salary per hour? *

16. Generally, are you available to work Mondays? *

17. Generally, are you available to work Tuesdays? *

18. Generally, are you available to work Wednesdays? *

19. Generally, are you available to work Thursdays? *

20. Generally, are you available to work Fridays? *

EDUCATION / SKILLS

High School

21. If applicable, name of your high school?

22. If applicable, city of your high school?

23. If applicable, year of high school graduation?

College Trade School

24. If applicable, name of last college/trade school?

25. If applicable, city of last college/trade school?

26. If applicable, year of last college class/trade school?

27. If applicable, specific study at school?

28. Any special skills for job you are applying for?

29. Do you speak any languages other than English?

30. Do you have any military service? *

FORMER EMPLOYERS

Latest / Current Employer

31. Lastest Employer Name

32. Latest Employer Phone

33. Latest Employer City

34. Latest Employer State

35. Latest Employer Position

36. Latest Employer Salary

37. Latest Employer Rreason for Leaving

Employeer #2

38. Former Employer 2 Name

39. Former Employer 2 Phone

40. Former Employer 2 City

41. Former Employer 2 State

42. Former Employer 2 Position

43. Former Employer 2 Salary

Employer #3

44. Former Employer 2 Reason for Leaving

45. Former Employer 3 Name

46. Former Employer 3 Phone

47. Former Employer 3 City

48. Former Employer 3 State

49. Former Employer 3 Position

50. Former Employer 3 Salary

51. Former Employer 3 Reason for Leaving

52. Have you ever been discharged from a job? *

53. If yes, explain:

54. Do you agree with having a photgraph taken if employeed? *

REFERENCES

Reference 1

55. Reference 1 Name *

56. Reference 1 Phone *

57. Reference 1 Relationship *

58. Reference 1 Years Acquainted *

Reference 2

59. Reference 2 Name *

60. Reference 2 Phone *

61. Reference 2 Relationship *

62. Reference 2 Years Acquainted *

Reference 3

63. Reference 3 Name *

64. Reference 3 Phone *

65. Reference 3 Relationship *

66. Reference 3 Years Acquainted *

EMERGENCY CONTACTS

Emergency Contact 1

67. Emergency Contact 1 Name *

68. Emergency Contact 1 Relationship *

69. Emergency Contact 1 Address *

70. Emergency Contact 1 Phone *

Emergency Contact 2

71. Emergency Contact 2 Name *

72. Emergency Contact 2 Relationship *

73. Emergency Contact 2 Address *

74. Emergency Contact 2 Phone *

POSITION SPECIFIC QUESTIONS

75. If appling for a CNA or Nursing position, is your license current? *

76. Do you have a have valid drivers license? *

77. Do you have car insurance? *

78. Do you have any physical defects that preclude you from performing any work for which you are being considered? *

ACKNOWLEDGEMENTS

1. I declare that the information provided by me on this application, or any other documents filled out in connection with my employment is complete and true to the best of my knowledge. I understand that any misrepresentation or omission on this application may preclude an offer of employment, or may result in a withdrawal of an employment offer, or may result in my discharge from employment if I am already employed at the time the misrepresentation or omission is discovered. The Federal Immigration and Reform and Control Act of 1986 requires that a DHS Employment Eligibility Verfication "Form I-9" be completed for every new hire and that within three (3) business days of beginning work every new hire must present to the employer documentation establishing his/her identify and authorization to work. This federal requirement must be satisfied as a condition of employment. I agree to notify the company immediately if I should be convicted of a felony, or any crime involving dishonesty, abuse or a breach of trust while my job application is pending, or during my period of employment, if hired.

2. I freely and voluntarily authorize the investigation of all statements contained in this application (and accompanying resume, if any.) I also authorize the company to contact my present employer (unless otherwise noted in this application form,) past employers and listed references.

3. I authorize any person, school, current employer (except as previously noted), past employer(s), and organization(s) named in this application form (and accompanying resume, if any) to provide the company with relevant information and opinion that may be useful to the company in making a hiring decision, and I release such persons and organizations from any legal liability in making such statements.

4. I understand that if my employment is terminated by the company for dishonesty, abuse, breach of trust, or any criminal acts, the authorities may be notified and I may be criminally prosecuted.

5. I EXPRESSLY AGREE AND UNDERSTAND THAT, IF EMPLOYED, MY EMPLOYMENT IS AT WILL NOT FOR A SPECIFIC TERM, IS BASED ON MUTUAL CONSENT AND MAY BE TERMINATED BY ME OR MY EMPLOYER WITH OR WITHOUT NOTICE OR CAUSE AT ANY TIME. I FURTHER UNDERSTAND THAT NO ORAL PROMISE, EMPLOYER POLICY, CUSTOM, BUSINESS PRACTICE OR OTHER PROCEDURE (INCLUDING THE BASIC EMPLOYMENT POLICIES, PERSONNEL HANDBOOK OR ANY PERSONNEL MANUALS) CONSTITUTE AN EMPLOYMENT CONTRACT OR MODIFICATION OF THE AT-WILL EMPLOYMENT RELATIONSHIP BETWEEN ME AND THE EMPLOYER. I UNDERSTAND THAT NO PERSON IS AUTHORIZED TO CHANGE ANY OF THE TERMS MENTIONED IN THIS EMPLOYMENT APPLICATION FORM.

6. I understand that applications for certain positions may be required to qualify for employment based on additional employment criteria. For example, I may be required to take job-related tests, take a driver's examination, pass a Level II background investigation; take a pre-employment drug test and I consent to the release to the company of any and all medical information, as may be deemed necessary by the company in judging my capability to do the work for which I am applying. If I am offered employment or start work before any required test is completed, my employment is contingent on a satisfactory result on all tests, examinations or information. (If hired, you will be required to supply a statement from a licensed physician or advanced registered nurse practitioner dated within 45 days prior to employment stating that you are physically fit to perform the duties of the job and are free from TB in a communicable form.)

7. I further understand that abuse, neglect, or exploitation of the elderly is cause for immediate dismissal.

8. I acknowledge that this application will remain active for 30 days from this date. If I have not heard from the Company at the conclusuion of this 30 day period; it is my responsibility to complete a new application if I still wish to be considered for employment.

After you press submit, your information will be sent to the HR department.

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