Employment Application

PERSONAL INFORMATION

We provide equal employment opportunities to all employees and applicants for employment with regard to race, color, ancestry, national origin, gender, sexual orientation, marital status, religion, age, disability, gender identity, results of genetic testing, or service in the military. Equal employment opportunity applies to all terms and conditions of employment, including hiring, placement, promotion, termination, layoff, recall, transfer, leave of absence, compensation, and training. It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors. Thank you for considering employment at Brookside Communities. Please fill out this application completely in order to be considered for employment.

EDUCATION/TRAINING

Please List Name and Address of Schools you have attended:

WORK EXPERIENCE

Please list your work history within the past 10 years beginning with your most current/recent employer.

PROFESSIONAL REFERENCES

Three references must be provided. No personal or relative references please.

AFFIDAVIT, CONSENT, CERTIFICATION AND RELEASE:

Please read the following statement carefully and acknowledge that you have read and agree to comply with it by providing the information requested below. I hereby certify that the facts set forth in this employment application (and accompanying resume if applicable) are true and complete to the best of my knowledge, and I agree and understand that any misrepresentation of information or failure to disclose information on this employment application may disqualify me from further consideration for employment and, if employed, may subject me to termination. I understand that in connection with my application for employment, I may be subject to a complete background check and drug screen if a conditional offer of employment is extended to determine my eligibility for employment. A positive drug screen or a failed background check will result in a withdrawal of the offer of employment. Brookside Communities comply with applicable Federal and state laws including the Fair Credit Reporting Act (FCRA) when conducting background checks. I understand that as a condition of employment, I may be required to provide proof of vaccinations, or obtain company provided vaccinations including a flu vaccination, in compliance with applicable laws. I understand that Brookside Communities require all associates to immediately disclose any exclusion, suspension or other event that makes me ineligible to participate in any Medicare or Medicaid program. I authorize Brookside Communities to obtain reference information on my work performance. I hereby release Brookside Communities from any and all liability at any time which could result from obtaining and making an employment decision based on such information. Finally, in the event I am employed, I understand I am required to abide by all company rules and regulations as a condition of employment. I also acknowledge this application is not a contract of employment and nothing herein should reasonably be construed as such. I do acknowledge that if employed, my employment will be "at-will," meaning either Brookside Communities or I may terminate the employment relationship at any time with or without cause. This company is a smoke-free workplace in compliance with state, local, and other applicable laws. DO NOT SIGN UNTIL YOU HAVE READ THE STATEMENT ABOVE. By my signature below, I certify that I have read, fully understand, and accept all terms of the foregoing statement. Please signify your acceptance by entering the information requested in the fields below.